Journal of Pharmacoeconomics and Pharmaceutical Management
Volume:8 Issue: 4, Autumn 2022

 Pharmaceutical sector in Iran is a generic-based market in which local manufacturers supply over 98% of sales volume and 85% of sales value, according to the latest published data by the Iran Food and Drug Administration (IFDA) in 2021. Share of imported generics and original brands from the market has been decreasing due to Iran MOH's cost-containment and localization support policies

The generalized conditional heterogeneous variance self-regression econometric method (GARCH-M) is used to analyze the data and estimate the actual exchange rate uncertainty index.

 Strict and unfair cost-plus approach in repricing could cause margin loss for local companies and put the sustainability of the whole local generic industry at risk.

Given the consequences of subsidized currency on the pharmaceutical and healthcare systems, the government's decision to eliminate subsidies from money seems rational and defensible. However, all concerns of different stakeholders must be heard and addressed before the implantation of this policy. With good budget raise for health insurance from subsidy elimination revenues (cross-subsidization) sources, the government should ensure that this policy will not burden any unaffordable cost or loss to either patients or industry. In addition, agility in the pricing, budgeting, and reimbursement processes is a critical success factor for MOH and IFDA to avoid harm to stakeholders.

This study aims to compare combination therapy efficacy and safety with tamsulosin plus dutasteride versus tamsulosin in benign prostatic hyperplasia.

  An online search was conducted in PubMed, Cochrane Library, Embase, Scopus, and Web of Science to identify the relevant published studies up to July 2021. The reference list of the critical review articles was searched as well. The Cochrane risk of bias was used to assess the quality of studies. Meta-analysis was performed using the RevMan software v.5.3.

   Six studies, including 6647 patients, were included.  A  significant improvement was observed in the combination therapy group compared to the tamsulosin group in terms of international prostate symptom score (mean difference [MD]=-2.59, %95 confidence interval [CI]: -4.20 to -0.99; P=0.002), prostate volume (MD=-10.13, %95 CI: -12.38 to -7.88;  P<0.05), maximum urine flow rate (MD=1.05, %95 CI: 0.82 to 1.29; P<0.05), transitional zone volume (MD=-3.18, %95 CI: -3.57 to -2.79; P<0.05), and prostate-specific antigen (MD=-0.54, %95   CI: -0.80 to -0.29, P<0.05). The result of the subgroup showed that tamsulosin 0.2 mg in combination therapy was not effective in terms of international prostate symptom score (MD=-2.97; 95% CI: -7.49 to 1.56; P=0.20). Adverse events were more in combination therapy regarding erectile dysfunction, retrograde ejaculation, decreased libido, ejaculation failure, any adverse events, and any drug-related adverse event (P<0.05). However, there was no significant difference between the two groups regarding dizziness and any serious adverse event (P>0.05).

 This meta-analysis showed that combination therapy has greater efficacy in treating patients with benign prostatic hyperplasia; however, it is associated with higher adverse events

Drug use evaluation studies are conducted to assess the pattern of prescribing and administration of a drug. Deep vein thrombosis is one of the most important clinical issues around the world. This study examined the pattern of enoxaparin consumption, one of the most widely used anticoagulant, for prevention and treatment of thrombosis in a non-teaching hospital.

In this cross-sectional prospective study, 117 patients receiving enoxaparin in different wards of Imam Sajjad Hospital in Ramsar, Iran were studied. Data on how to prescribe and use of enoxaparin were recorded in a questionnaire designed according to UpToDate recommendations. Demographic variables, prophylaxis and therapeutic indications, prophylaxis and treatment doses, interval and monitoring information were evaluated. Finally, the results were compared with UpToDate suggestions.

The mean age of patients was 68.9 years and 52.1% of them were men. Enoxaparin was prescribed for 35.9% of patients as prophylaxis and 64.1% of patients received this drug for the treatment. Overall, prophylactic doses were inappropriately administered in 41.5% of patients. Improper therapeutic doses were also prescribed for 52% of subjects.

The results of this study showed that the dosage and interval of enoxaparin administration were significantly inappropriate. It seems, the prescribers must consider more adherence to enoxaparin guidelines and reliable sources for more rational practices.

The aim of study was investigating the effect of exchange rate uncertainty on pharmaceutical exports in Iran, which was studied by longitudinal studies from 2003 to 2018. The statistical population was pharmaceutical companies active in the field of exports based on data, information and reports. Were selected officially. To analyze the data and estimate the real exchange rate uncertainty index, the generalized conditional heterogeneous variance self-regression econometric method (GARCH-M) is used. Petroleum GMM econometric technique was used using EVIEWS econometric software. According to the results, non-oil exports in the Iranian economy is a key variable because its prosperity is a sign of existence and continuity of the country's economy and the government itself for continuous growth and The economy is competitive and the performance of non-oil exports and its trend in Iran has not been favorable. Although the massive import of goods and services into the country over the past years has been continuously financed through revenues from oil exports, the slowness of non-oil exports will hamper both productivity growth and future foreign exchange needs.

Coronavirus (COVID-19) pandemic has caused great shocks across all sectors of society. The pandemic highlighted three crucial policy issues (i.e., healthcare spending, social determinants of health, and health equity). It is also projected that recurrent wintertime outbreaks of COVID-19 will likely occur after this initial wave in the next few years.

Descriptive review was conducted to provide information on the critical lessons learned from the first wave of COVID-19 to improve the well-being of society in light of predicted future waves. We searched articles from PubMed/Medline, Scopus, Embase, and Google Scholar with systematic search inquiry.

We included 96 articles in this descriptive review. Health is the ultimate goal of the healthcare sector and an essential prerequisite for achieving other societal goals. The first wave of the COVID-19 pandemic showed that countries that have given less attention to social determinants of health (SDH), health equity, and marginalized, vulnerable populations faced the tremendous burden of disease morbidity and mortality. Spending on healthcare or other developmental sectors should be based country’s health production function status (i.e., understanding the marginal return of healthcare). Health and well-being are indivisible from other societal goals. It should be addressed with due consideration of their interconnectedness. A comprehensive multi-disciplinary approach involving health in all policies, which integrates SDH and health equity into modeling with the principle of leaving no one behind, will have a critical impact on improving economic and health outcomes during future anticipated COVID-19 Waves.

In general, improving and adopting novel strategies, confronting the multiple facets of the public health mitigation measures, and facilitating and stimulating interdisciplinary public health interventions are essential to reduce the health and economic impacts of anticipated future COVID-19 waves. Developing countries could benefit from increasing public expenditure on health with due consideration of SDH. For developed countries like the United States, it is imperative to shift health policy focus from illness-oriented healthcare towards policies that affect the social determinants of health.