ali akbari-sari

Rare diseases, characterized by low prevalence and high complexity, pose significant challenges to health systems due to the uncertainty surrounding the best diagnostic methods and availability of effective treatments.

This study aimed to introduce new methods for prioritizing orphan drugs, with a pilot application to hemophilia, spinal muscular atrophy (SMA), cystic fibrosis (CF), and multiple sclerosis (MS).

This quantitative research, conducted at Iran’s National Institute for Health Research from 2021 to 2023, employs multi-criteria decision-making models (MCDA) to evaluate the efficacy of health care technologies for "rare and hard to cure" diseases. A preliminary model was developed based on a pilot selection of seven medications, for which comprehensive data was extracted. The clinical efficacy was assessed using quality adjusted life years (QALY) as a metric. The model design was grounded on three critical factors: The annual cost of intervention per individual, the annual number of eligible patients for intervention, and the Proportion of expenses covered by the governmental budget. Additionally, the model incorporated various constraints and a regulatory coefficient, denoted as “w,” to enhance its robustness.

By running the model, the coverage of selected medications through model optimization, revealing the following percentages: Alemtuzumab (30%), ocrelizumab (30%), emicizumab (6%), dornase alfa (29%), tobramycin (2%), and spinraza (0.02%). Additionally, the corresponding monetary coverage in Iranian Rials is reported as follows: Alemtuzumab (27,144,000,000 IRR), ocrelizumab (109,645,200,000 IRR), emicizumab (17,360,490,000 IRR), dornase alfa (43,350,930,000 IRR), tobramycin (1,268,505,000 IRR), and spinraza (350,000,000 IRR).

This model has tried to solve the shortcomings of the existing models regarding the prioritization of orphan drugs by combining different factors to improve access to essential treatments for rare diseases, although it can be generally asserted that no unique model can answer all policymakers’ questions regarding budget allocation of rare diseases and orphan products.

  This study aims to review tools that have been developed for the transferability of health technology assessment (HTA) information to different countries. HTA is increasingly being used as a tool in health policy decision-making, but its complexity and lack of local expertise have limited its usage in many countries. The World Health Organization (WHO) has taken measures to encourage countries to conduct and use HTA, including through resolutions from the Eastern Mediterranean (EM) Regional Committee in 2019. However, due to limitations in national technical capacities, there is a need to adapt HTA information from other settings to fit the specific context of each country. Therefore, this study aims to systematically review the tools that have been developed for HTA transferability and assess their strengths and limitations. 

The systematic review included studies that introduced tools, methods, and frameworks for transferability of HTA information across jurisdictions. Databases such as MEDLINE, EMBASE, Cochrane Library, Epistemonikos, Web of Science, health economic database, Scopus, and Google Scholar were searched, along with relevant bibliographies. The data was extracted and synthesized using both tabulation and narrative approaches. The evaluation of the tools involved assessing various criteria, such as user-friendliness, efficiency in screening, and considerations regarding transferability factors. 

A total of 10 375 documents were evaluated, resulting in 17 studies that met the inclusion criteria. These 17 studies consisted of 13 newly developed tools/methods that were appraised. The majority of the models were checklists, with only a few deemed suitable for full HTA. Three models have been validated through published studies, but there is no evidence of utilization in the countries of the EM region. 

  While the existing tools provide valuable resources for evaluating transferability, there remains a need for a more comprehensive tool to support decision-makers in low-resource settings considering country context and capacity.

We aimed to review the effect of community-based health insurance on health-related outcomes in Ethiopia.

A systematic review was undertaken utilizing a major relevant published literature review from September 2017 to June 15, 2023. PubMed, Scopus, Web of Science, Science Direct, Google Scholar, Semantic Scholar, EMBASE, ProQuest, Hinari, and the Cochrane Library were used to search for relevant literature. Moreover, the Prisma flow model was used to select eligible findings.

Overall, 72% of the articles employed cross-sectional comparative study designs and procedures, and 36% of them employed samples ranging in size from 501 to 1000 participants. Furthermore, 76% were studied using descriptive statistics and logistic regression, whereas fewer utilized a random model, a probity model, or a correlation model. Similarly, 32% of the research used two-stage stratified sampling methods, and around 40% of the data revealed that the scheme increased healthcare utilization services. About 72 % of the reviewed study results showed that the scheme reduced catastrophic health expenditure and increases utilization of healthcare services. And the 20% reviewed studies stated that the CBHI boosts household satisfaction level. Moreover 12% of the reviewed studies stated that, CBHI increased QoL (quality of life).

Most of the studies provide evidence of the positive effect of CBHI in Ethiopia. Mainly, its membership improved the utilization of health services and decreased the incidence of catastrophic health expenditures. Thus, all actors should cooperate to strengthen it to solve the effective attribute of the deprived value of health care and continuity of care delivery system related to the country's new policy.

Financial protection against the health expenditures is one of the important dimensions of Universal Health Coverage (UHC) and a major goals of health systems. Monitoring and tracking indicators related to it are of great importance for policymakers. The aim of this study is to examine the eleven-year trend in households’ exposure to Catastrophic Health Expenditures (CHE) and Impoverishing Health Expenditures (IHE).

This study is a secondary analysis on the 2011 to 2023 data from the national household income expenditure survey, obtained from the Statistical Center of Iran. The trend in households’ exposure to CHE and IHE was analyzed by type of service, the expenditure quintile and the place of residence.

The proportion of households exposed to CHE (health expenditures exceeding 25% of total household expenditure) increased from 3.10% in 2011 to 2.85% in 2023. In urban and rural households, this proportion changed from 3.01% and 3.30% to 2.55% and 3.86%, and in poorest and richest quintiles from 1.28% and 6.31% to 1.99% and 5.14% respectively. The proportion of households exposed to IHE increased from 0.60% in 2011 to 0.80% in 2023. This proportion in urban and rural households reached from 0.32% and 1.29% to 0.40% and 2.11% respectively.

The increasing trend of financial hardship among the poorest quintile in Iran will significantly hinders the achievement of UHC, suggesting the necessity of more serious interventions.

Screening is a cost-effective method for prevention, early detection of the disease and reducing the burden of the third deadliest cancer in the world, i.e. colorectal cancer. This study aimed to analyze the cost-effectiveness of colonoscopy screening compared to sigmoidoscopy for colorectal cancer in high-risk individuals in Iran.

This economic evaluation study was conducted using the cost-effectiveness method between July 2016 and February 2017. Evaluation of the effectiveness of screening methods was done using a systematic review. Cost evaluation was also done using the costs obtained from the tariff approved by the Iranian Ministry of Health in 2015 for colonoscopy and sigmoidoscopy. Finally, the combined model of decision tree and Markov was used to evaluate the cost effectiveness. Incremental Cost Effectiveness Ratio (ICER) formula was used for cost effectiveness analysis considering the final outcome of 5-year survival of high-risk individuals. Excel and TreeAge software were used for data analysis.

The effectiveness of sigmoidoscopy and colonoscopy in increasing 5-year survival is 11 and 15.7%, respectively, and colonoscopy screening is 4.7% more than sigmoidoscopy. The cost of colonoscopy and sigmoidoscopy screening was calculated as 1000 and 19920 billion Rials, respectively. Based on cost-effectiveness analysis, the cost of treating patients in the case of screening with colonoscopy and sigmoidoscopy is lower than without screening. The ICER ratio of colonoscopy and sigmoidoscopy compared to no screening was -4/441/389/160 and -4/757/954/940 Rials respectively, and colonoscopy compared to sigmoidoscopy was -3/699/785/880 Rials, respectively. Finally, the use of colonoscopy leads to spending 3/699/785/880 Rials less in exchange for obtaining 4722 additional survivals with the prevention of colorectal cancer compared to sigmoidoscopy.

Screening by colonoscopy and sigmoidoscopy methods are effective in reducing the incidence and death of colorectal cancer compared to no screening. Screening by colonoscopy is a dominant option for the high-risk population in Iran. Colonoscopy screening is more cost effective compared to sigmoidoscopy. However, decisions about colorectal cancer screening and screening methods depend on local resources and personal preferences.

 Due to the nature of healthcare services, decisions leading to changes in hospital processes are more sensitive. Therefore, managing change in hospitals requires special attention. This study was conducted with the aim of providing a framework for initial stakeholder engagement in hospital change management to improve efficiency.

 This applied study by qualitative method and nominal group technique with a targeted selection of 22 people, including 68% women and 32% men, with an average experience of 8 years ,with leadership experience or involvement in successful change processes in hospitals or relevant research at Mashhad University of Medical Sciences were purposefully selected. In total, eight main sessions and ten smaller sessions were conducted. The sessions were managed using the Potter nominal group technique in five stages: topic clarification, idea generation, idea sharing, discussion, and voting.

 The four main solutions included: 1)examining the acceptance of change in hospitals (including six actions: examining characteristics, history, the culture of change, achievements, related actions, decision-making centers, and examining resistance status in upper-level institutions); 2) stakeholder analysis (including identifying stakeholders, determining their power and interest levels, drawing a matrix, and identifying key stakeholders); 3) examining the level of acceptance by key stakeholders (including disbelief, belief, trust, and confidence levels); 4) engaging key stakeholders with a participatory approach (including using dialogue, deep conversation, and work partnerships).

 Effective change management at the hospital level requires sufficient attention to stakeholder engagement. In this study, the necessity of understanding key stakeholders, considering their acceptance level, and engaging them through appropriate participatory strategies within the organizational culture were emphasized for the success of the initial stakeholder engagement process.

Today, according to the phenomenon of globalization and the progress of modern societies and technology, we face numerous changes in all aspects of life, therefore privatization processes have inevitably become a part of normal life. So privatization of higher education is inevitable.

Methods and Materials: 

In this paper, which is Applied Research; set in the (analytical and descriptive) method. This research was done by systematic review method. The Google Scholar database was selected as a reliable database, and the articles were searched according to keywords. The selection criteria included the language of the articles (Persian and English), access to the full text, and the last 15 years from 2008 to 2023. The number of articles obtained was 118, after removing duplicate and unrelated items, 35 articles were selected. After careful study based on research objectives and questions, the number of articles reached 19. Finally, the analysis was done based on the findings.

Privatization in higher education increases the efficiency and quality of education. It responds to the high demand of the society. It reduces the pressure on the government budget. Higher education is available to all. It is student-oriented and pays more attention to the challenges and problems of students. On the other hand, it makes education become a privilege. It has caused the university to move away from its main mission, which is to be academic, and market influence increases due to the change of values.

The process of privatization higher education needs a fundamental revision. it is essential to know current situation. In order to survive, private higher education has to improve the quality of its activities and reduce costs. Privatization of higher education needs systematic study and planning in order to solve the deficiencies and obstacles.

We aimed to investigate the existence of unnecessary demand for angiography and the factors affecting it to provide evidence for decision makers.

This longitudinal panel study was conducted in public hospitals in Tehran, Iran by using 2458 patients' records that were undergoing angiography for suspected coronary artery disease 2013-2015. To modeling the physicians' behavior based on physician-induced demand (PID), the patients were classified as appropriate, uncertain, and inappropriate and then Hierarchical Linear Modeling (HLM) model besides the physician ethic index was developed and finally the existence of PID showed based on three scenarios.

Angiographies were performed inappropriately in 23.8% of 2458 patients as well 46.7% were uncertain, and 29.5% were appropriate. According to the HLM model, the physician-to-population ratio (δ0= - 0.161) and the interaction variable coefficient are higher than zero and significant (δ1 = 253). The results of the physician ethic index showed that most physicians were at a moderate rate, meaning that their utility was a combination of both pecuniary and non-pecuniary profits (0< │εpδ │<1). Considering the HLM model and the medical ethics index together has almost shown the condition of PID (the necessary condition δ1> 0 and the sufficient condition (1 ≤│εpδ│)) existed for about 26% of all studied physicians who had pure profit maximizer.

To reduce induced demand and improve medical ethics adherence in cardiologist, policy makers should develop native guidelines, rules, and instructions besides policies related to education, and increasing patients' awareness.

Considering changes in the structure of Iran’s population, the prevalence of cancer is increasing. Increasing social awareness about cancer and screening for cancers are the most cost-effective approaches for breast cancer prevention. Studies show a significantly low rate of regular breast cancer screening behaviors. Given the importance of breast cancer and the decreasing effect of screening methods on the financial burden and disease complications, awareness about their attitude can provide appropriate information for Policy-making about breast cancer screening methods in Iran. This study aimed to investigate the attitude of women over 40 years-old visiting health centers affiliated toward breast cancer screening methods.

This is a descriptive/analytical study performed cross-sectionally in the health centers affiliated with TUMS. Two hundreds fifty-five women from Imam Khomeini Hospital Complex and some health centers that were subsidiaries of the south health centers of TUMS, were enrolled. To collect the required data, we developed a questionnaire based on tools used in similar studies. We used the Chi-square test to investigate the relationship of the attitude score with demographic and socioeconomic variables. The statistical analyses were performed in STATA.

About 77.6% of the participants agreed that breast cancers detected earlier are almost treatable. About 18.9% of the participants believed that (agree and highly agree) they will not develop breast cancer in the future, and 47.8% had no idea; 68.2% of the participants disagreed with the item “breast cancer is almost incurable even if detected in early stages;” about 22.0% of them believed that they are at higher risks for breast cancer compared to other women, and 61.3% of the participants agreed to visit a physician in case of feeling pain or a mass in the breast

The attitude of the Women participating in the study toward breast cancer screening is high; this finding can be used in plans aiming to raise awareness and conduct screening in Iran.

 Writing any study requires compliance with specific standards in its field specialization, CHEERS, or consolidated health economic evaluation reporting standards, is a special tool for reporting on how to write economic evaluation studies in the field of health, which We decided to review the standards of economic evaluation studies in Iran.

 For this purpose, we searched for Keywords related to Iran and CHEERS and combined them in PubMed and Scopus databases, in which we conducted economic evaluation studies that were conducted in Iran and reviewed by other researchers with relevant tools. 

 A total of 13 secondary Articles, including 40 original articles, were found as eligible. The highest reported components were Incremental costs and outcomes, Background, and objectives, abstract, title, comparators, and component 22; i.e., study findings, limitations, generalizability, and current knowledge. However, in the report of components of funding sources, Measures of effectiveness and Characterizing heterogeneity are seen as weaknesses. In total, the average score of cheers for Iranian studies was reported with an average of 84.33 and a standard deviation of 15.15.

 In total, 80% of Iranian studies had met the standards at an excellent and very good level, and only three studies (7.5%) reported poor standards. However, there are still areas for improvement in the report of some Items.

Hypertension is a common public health problem with potentially serious consequences. We aimed to explore the direct costs of hypertension treatment in Iran.

Literature review and STEPS survey were used to estimate the incidence and prevalence of hyperten-sion for Iranian males and females and the proportion of its treatment coverage in 2020. A standard national protocol for hypertension treatment was used to estimate the required medical services including visits, medica-tions, and lab tests. The cost of each service and the total cost of the disease were identified using the national reference costs.

About 23.39 million people suffer from moderate systolic blood pressure (BP of 120 to 139 mm/Hg) and a further 14.6 million people had severe BP (≥140 mm/Hg). Nearby 39.8% of these patients, receive BP treatment. The direct costs of hypertension treatment were 19,006.08 billion IR Rials (USD 87.54 million), of which 16.60% and 83.40% of the costs were related to new and prior cases, respectively. The costs of patient visits, medications, and lab tests were 56%, 35.51%, and 8.49% of the total costs, respectively.

The prevalence and economic burden of hypertension are relatively high in Iran. Early detection and treatment of hypertension might have a significant effect on reducing its complications and costs.

Equitable financing is an important goal of health systems and protecting the financial risks of health care. Also, equitable financing of health is important both for improving the state of health systems and for achieving universal health coverage (UHC). In this study, with an overview has introduced the indicators of justice in health and the results of the indicators in this field have been examined in the country. The search for articles in the present study is of a review type that was conducted through search engines and databases within the range of 2002-2022. In order to identify the advantages and disadvantages of indicators showing justice in health financing, including out-of-pocket payment indicators, catastrophic health expenditures index, Kakwani index, concentration index and fair financial contribution index, a review of studies was used and the limitations and advantages of each index were extracted and compared. The results of this study showed that in terms of health equity index, the index of back-breaking health costs had the highest frequency in the studies. Each of the indicators had advantages and problems. Also, according to the numerous studies on the calculation of the health justice index, the existence of a health watchdog is necessary to monitor these indicators.

Vaccination is a strategy for controlling the COVID-19 pandemic. After the vaccine is produced, the utilization of the vaccine becomes crucial.

The study aims to investigate the public attitudes toward COVID-19 vaccination in Iran.

A cross-sectional study was conducted in Iran from March 21 to July 6, 2021. The questionnaire collected attitudes towards the COVID-19 vaccination and priorities for COVID-19 vaccination. Based on the formula for calculating the sample size to estimate the ratio, the sample size was approximately 715 people. A convenience sampling technique was used to select participants. Data were collected both online and face-to-face from individuals over 18 years old. Logistic regression analysis was used to analyze the factors predicting willingness to pay for vaccines.

About 46% of the participants stated that they would use the COVID-19 vaccine, and 36% of them stated that their use of the vaccine depends on the type and specifications of the vaccine. About 71% were willing to pay for a COVID-19 vaccine. The most important reason for not using the vaccine was "concerns about side effects of the vaccine" (44.9%). About 88% of respondents agreed that the COVID-19 vaccine should be free for everyone, and 56.6% favored that COVID-19 vaccination should be mandatory and everyone should be vaccinated. There was a significant relationship between the willingness to pay for the vaccine with educational status and the perceived risk of being infected with COVID-19 (%). Healthcare workers (31.4%) had the highest priority for receiving the COVID-19 vaccine.

Most respondents were willing to receive and pay for the vaccine. The results provide useful information for decisionmakers to identify individual and social values for a suitable vaccination strategy.

Exploring and analyzing the cost of medicines is an important tool for their management and planning. This study aims to analyze the utilization and costs of parenteral anti-diabetic medications during the past decade and predict the future trend of these medications from 2021 to 2031 in people that are covered by Iran Health Insurance Organization (IHIO).

This study was based on secondary analysis of data routinely reported to IHIO from 2011 to 2019. For each drug, the Defined Daily Dose (DDDs) and DDDs per 1000 inhabitants per day were calculated for the last 9 years according to the WHO protocol. Then a regression analysis was used to predict the utilization trend of each drug for the following 10 years.

The overall utilization of injectable antidiabetic drugs has constantly increased during the last nine years. This increasing trend is estimated to continue during the next decade.

In Iran, the increase in the diabetic population and better access in the future will be the main reasons for the increase in the utilization of various insulins. The increasing trend of utilizing injectable antidiabetic drugs in Iran might be partly due to new patients and partly because of improvement in patient access to new treatments. This also suggests that, compared to the average in the commonwealth countries, Iranian diabetic patients has faced lack of drug utilization in the past decade that is gradually reducing.

In order to achieve development goals, in addition to providing students with physical health, their mental and social health should be considered as a necessity and priority in development programs. This program, called the Nemad Project in Iran was formally established in 2015. This study aims to explore the challenges of the Nemad project in Iranian schools based on stakeholders' views.

The present qualitative study, with a contractual content analysis approach, was conducted on 21 experts in the field of social harm prevention and mental health promotion at the senior, intermediate, and operational levels in educational institutions and schools, Ministry of Health, the Judiciary and the Planning and Budget Organization. These experts also included project technical officers. Participants were selected using snowball and purposeful sampling methods. Data were collected through semi-structured interviews and analyzed by coding, classification, and extraction of the main themes.

Six main themes were derived that included inefficiency in resource management (with subcategories of inadequate facilities and equipment, inadequate human resource management, and information management system deficiencies), weakness in program organization (with subcategories of poor cross-sectoral and weak inter-sectoral subgroups), challenges of laws/regulations/policies (with sub-categories of defective protocols and guidelines and lack of specific task descriptions), barriers and challenges to implementation of policies (with macro and school policy implementation subcategories), structural factors (with subcategories of financial resources allocation problems, inconsistency in managerial levels, and deficiencies in decision-making principles), weaknesses in educational processes (with subcategories of inadequate teacher education, weaknesses in parenting courses, and weaknesses in student education), and ultimately, weaknesses in monitoring and evaluation (with the subcategory of lack of a monitoring and evaluation system).

According to experts, implementation of mental and social programs in schools is not in a desirable situation and is faced with certain challenges. To enhance the management of the Nemad project in Iranian schools, it is necessary to compile flowcharts of service delivery and inter-device communication, allocate resources to meet the expectations of each organization, do performance-based budgeting, take a comprehensive look at parental issues, and design a system of monitoring and evaluating the requirements.

In recent decades, due to the increasing health expenditures and resource constraints, the economic evaluation studies results have been increasingly used to prioritize health interventions and resource allocation in most countries, especially in high-income countries. Economic evaluation studies allow health system policymakers and decision makers, including physicians, to select the most appropriate intervention scientifically and systematically by comparing the costs and consequences of different treatment interventions. In Iran, The results of economic evaluation studies are used to decide on the arrival of new drugs in the country as well as insurance coverage for medical interventions since a decade ago. However, many researchers and clinical professionals still do not have enough information about the types of economic evaluation studies and the principles of conducting these studies. In this article, while defining economic evaluation studies, the difference between these studies and other studies in health sector is stated. Then the main types of economic evaluation studies including cost-effectiveness, cost-utility and cost-benefit are described and the differences between these methods are expressed. Finally, the general principles of conducting economic evaluation studies in the health sector are explained.
 Understanding these principles and their implementation by researchers, while improving the quality of economic evaluation studies, provides the opportunity for policy makers and decision makers in health system to compare the results of these studies with each other and their findings to make decisions about the allocation of resources between different health interventions

Referral system is one of the principles and foundations of primary health care services. One of the most important challenges and problems of the referral system is the lack of public awareness of its nature, services and benefits. The aim of this study was to provide a model for accepting the referral system from the perspective of patients.

This study was a mixed method that was conducted in three steps in 1400. The first step included the development of a questionnaire, the second step was a survey study, and the third step was the design of the acceptance model of the referral system from the perspective of patients. The statistical population included 384 patients covered by the Rural Insurance Fund referring to the Imam Khomeini Hospital Complex. The data were analyzed using SPSS v20 software. Also, Second-order Confirmatory Factor Analysis (S-CFA) was performed using LISREL v8.5 software.

Cronbach's alpha ratio for the whole questionnaire was 0.85 and intra-cluster correlation coefficient was 0.69. The results of confirmatory factor analysis showed that patient-centeredness, rules and regulations, responsiveness, coordination, security, accessibility, effectiveness, efficiency, personal beliefs and social influence significantly affected the acceptance of the referral system from patients' perspectives.

It is necessary for managers and policy makers before and during the implementation of the referral system to consider the factors affecting the acceptance of the referral system from the perspective of patients. For the appropriate implementation of the referral system, special attention should be paid to all the influencing factors so that patients can easy and convenient access health services anywhere and anytime.

Pre-hospital emergency medical services are one of the vital parts of the health system, which was created to timely diagnose and treat patients injured in life-threatening conditions. The use of motorcycles has increased in recent years to reach the golden time standard and overcome traffic in some countries, especially Iran. This study was conducted to investigate the effectiveness of a motor ambulance compared to an ambulance in Tehran City, Iran.

The present study is a cross-sectional descriptive-analytical type. The time to reach the patient’s bedside, death at the scene, and physiological parameters of the patient at the time of delivery to the hospital were studied as effectiveness indicators in this model. Since the primary data on the effectiveness of these two interventions is mortality, according to previous studies, the mortality data should be converted into the form of prevented mortality and enter the analysis phase. In this study, since the mortality index is expressed as a percentage, the difference in the mortality index from 100 was estimated as the prevented mortality index and entered into the analysis.

The results showed that the chance of death in the motor ambulance group with an ambulance in severe level patients is 44.8% and 66.9% in the ambulance group. In the motorcycle and ambulance group, the probability of death for patients with mild and moderate injuries was estimated at 0.02% in ambulance missions and 0.7% in motorcycle and ambulance missions (P=0.05). 

According to the desired outcome (reduction of death), the use of motor ambulance with ambulance was effective in severe group patients. Of course, this outcome alone cannot be an accurate basis for judgment, and outcomes such as survival, disability-adjusted life years, and quality-adjusted life years seem necessary for a more accurate evaluation.

Clinical Practice Guidelines (CPGs), are "recommendations intended to optimize patient care based on systematic reviews of available evidence and assessment of the benefits and harms of alternative care options". CPGs play an important role in improving the quality of care, reducing the diversity of treatment methods, reducing medical errors, managing health costs and increasing patient safety. This study was conducted with the aim of analyzing the decisions, consequences and policy trends of using CPGs in Iran during the period 2001-2021.

This study was a type of health policy analysis, carried out using analysis of the policy process approach. Data were collected through reviewing policy documents (n=79) and qualitative interviews (n=27). Analysis of policy documents was done using the content analysis method, the software used being Excel software, while for analysis of the interviews the framework analysis method was used, the software being the MAXQDA10 software.

The policy of using CPGs in Iran started in 2001 and has improved over the past two decades. During the period 2016-2021 a total of 836 CPGs (knowledge products) were published, but according to the participants, many of these CPGs or knowledge products did not have the necessary quality and were not used by physicians. The findings of this study also showed that in Iran there is a suitable atmosphere for implementing CPGs and the policies of using them are sound policies; however, there is a huge gap between the development and implementation of CPGs.

Although the process of applying CPGs has improved in Iran, their implementation faces challenges and, thus, they have not been fully implemented. Therefore, there is a need to adopt new standard methods and approaches to improve the quality and reliability of CPGs. Certainly, the support of the government, Ministry of Health and Medical Education, the medical community, insurance organizations and other stakeholders, along with proper collaboration and appropriate policy formulations, are essential to achieve success.

Regarding the growing burden of non-communicable diseases (NCDs) and exposure to their risk factors, and the continuous need for nationwide data, we aimed to develop the latest round of the STEPwise Approach to NCD Risk Factor Surveillance (STEPS) survey in 2021 in Iran, while the COVID-19 pandemic was still present.

In addition to the three main steps of this survey, including questionnaires, physical measurements, and laboratory assessments, we adapted the survey with the situation caused by the COVID-19 pandemic, by adding to various aspects of study phases and changing some scientific and executive procedures in this round of STEPS survey in Iran. These changes were beyond the initial novelties embedded within the survey before the pandemic, by refining the study protocol benefiting from the previous experiences of the STEPS survey.

By amending the required changes, we could include a total of 27874 individuals in the first step of the survey. This number was 27745 and 18119 for the second and third steps. Comparing the preliminary results with the previous nationwide surveys, this study was highly representative on both national and provincial levels. Also, implementing the COVID-19 prevention and control strategies in all stages of survey led to the least infection transmission between the study investigators and participants.

The novel initiatives and developed strategies in this round of Iran STEPS survey provide a state-of-the-art protocol for national surveys in the presence of an overwhelming catastrophe like the COVID-19 pandemic and the triggered limitations and shortages of resources.

To improve healthcare services’ quality, countries should measure their health systems’ efficiency and performance by robust methods.

We aimed to develop a national study to measure the efficiency of the health system in Iran.

The literature review identified several methods for measuring efficiency; the most common one was data envelopment analysis (DEA). We adopted DEA, but its findings were simplistic and inaccurate, so we began to modify the method by determining the weight of each indicator. We identified the efficiency measurement indicators, in line with international standards and uniformed units, and then readjusted our input/output indicators according to the study context through four expert panels. We collected data and classified the input/output indicators, followed by determining each indicator’s weight and standard limits. Then we rationalized our previous results by applying the revised model. The initial new results of the refined model were valid, accurate, and consistent with previous studies, as approved by experts. We defined proper modeling to achieve the stated objectives. After investigating various DEA models, we finally designed a new model that was consistent with the existing data and conditions, entitled EDEA (extended DEA), to analyze other subprojects.

The conventional DEA methods may not be accurate enough to measure health systems’ efficiency. By modifying modeling process, we propose a modified DEA with a very low error rate. We suggest that others interested in measuring health system efficiency adopt our modified approach to increase accuracy and create more meaningful policy-oriented results.

Context: 

In the first stage of viral replication, COVID-19 may cause a remarkable inflammatory response in patients. Paxlovid is an oral antivirus medicine that functions through the inhibition of one of the essential enzymes to viral replication, called protease. The present study intends to help policymakers decide on using Paxlovid in COVID-19 treatment.

Evidence Acquisition:

 This rapid review searched databases including Cochrane, PubMed, and Google Scholar by the end of July 2022. The inclusion criteria were randomized clinical trials investigating the safety and effectiveness of Paxlovid oral medicine at different doses in COVID-19 patients, compared with placebo or other routine care methods.

Based on the results (from three studies meeting the inclusion criteria), Paxlovid has no serious side effects, but when used, the patients must be checked for renal and hepatic failure, as well as drug interactions. Patients treated with this medicine within five days after the symptom onset were hospitalized, with 1% (6/607) in the Paxlovid group and 6.7% (41/612) in the placebo group. Also, no fatalities were reported in the Paxlovid group until day 28, while 10 (1.6%) patients died in the placebo group.

Paxlovid is very effective in outpatient treatment and comes in a combination pack containing nirmatrelvir 150 mg and ritonavir 100 mg film-coated tablets, to be taken twice daily for five days after the symptom onset in adults and children (over 12 years old and a minimum weight of 40 kg) who have mild to moderate symptoms of COVID-19 in order to prevent severe disease, which may lead to hospitalization and death. However, there is high uncertainty about the possibility of drug interactions.

Although breast cancer is the most prevalent type of cancer among Iranian women, its screening is opportunistic in Iran. The available guidelines for breast cancer screening are based on mammography. A screening modality should have adequate diagnostic accuracy and be widely available at reasonable cost. Although mammography is highly accessible in Iran, its accuracy has not been investigated.

This study aimed to evaluate the accuracy of mammography in opportunistic screening regarding the current rate of patient attendance.

A total of 491 women undergoing screening mammography were followed-up based on their medical records. They were divided into positive and negative screening groups, based on the breast imaging-reporting and data system (BI-RADS) categories and approaches. To evaluate the disease status of positive cases, pathology reports were investigated, and negative cases were followed-up for stability over time.

In the study sample, sensitivity was estimated at 73.08% (95% CI: 55.21 - 88.93), specificity was estimated at 94.41% (95% CI: 91.91 - 96.32), and accuracy was 93.28% (95% CI: 90.69 - 95.33). These test accuracy indices were not significantly different between the groups regarding age, family history, breast density, and history of breast interventions.

The test’s sensitivity or ability to detect a disease was relatively low in opportunistic screening; it was found to be similar to the results of studies of first time implementation of screeninng. In both settings, a test needs to diagnose both incident and prevalent cases. The overall accuracy of mammography was acceptable, even in opportunistic screening.

In the first stage of viral replication, Covid-19 may cause a remarkable inflammatory response in patients. Molnupiravir is an oral antiviral medicine which functions through inhibiting the viral replication of RNA viruses including Corona virus (SARS-CoV-2). The present study intends to help the policymakers decide on using of this medication in Iran. This study is conducted on Jan. 22, 2022 (from Jan. 2014 -the year of molnupiravir production for treatment of RNA virus diseases), using a rapid review of evidence as well as reviewing reliable databases including the Cochrane library, PubMed and Google scholar. The inclusion criteria were the randomized controlled trials that investigated the safety and efficacy of Molnupiravir at different doses in patients with Covid-19, comparing with placebo or other routine care methods (Population: Covid-19 patients, Intervention: molnupiravir, Control: placebo or other routine care methods, Outcome: Safety, Efficacy and Economic status, Study design: the randomized controlled trials or HTA reports). Prescription for oral administration in 800 mg dose twice daily for 5 days to inpatients and outpatients with mild, moderate or severe symptoms in the early stages of the disease (viral phase) had the most desirable level of efficacy. This medicine has no serious side effects; since the mutations caused by this medication have not been clarified yet, it is not recommended during pregnancy and/or for women planning to become pregnant. According to the manufacturing company, in the United States, each drug package is priced at $712 for a 5-day treatment period. Molnupiravir can be used in outpatients and inpatients (Over 18 years old) with moderate or severe symptoms in the early stages of the disease. But it is not recommended during pregnancy and/or for women planning to become pregnant.