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Background: Initiatives to improve the quality of health services and reduce costs currently have centered around payment mechanisms. In Iran, like many other countries, the outpatient visit costs are paid via fee for service, while real-time visits and other details of provided services are not considered in the tariff setting process. This study attempted to calculate the visit costs of various service provider groups and compared them with tariffs. Methods: In this cross-sectional research, the essential data about different costs were collected from providers' offices, standard time of each visit was achieved from Iran's Ministry of Health and Medical Education, current visit time of service providers was calculated based on health insurance companies' data across the country. After calculating the standard and current visit costs through the activity-based costing technique, main determinants of costs (major cost centers) were specified for use in probably future weighted tariffs in fee for service payment mechanism. Results: The greatest difference between standard and the current number of visits was found in the Sub-specialist physician group (6784 in a year), and the greatest difference was between standard and current cost of visits in sub-specialist psychiatrists (126703 IRR). Staffing and rental cost centers account for the highest share of total visit cost (87 %). Conclusion: This study demonstrated a significant difference between the current and standard visit costs with tariffs. Therefore, it is essential that policymakers improve the payment mechanism by modifying the visit tariffs for medical service providers. One suggestion in this way is using domestic relative value units according to costing research results.

Objective: To determine the potential effect of environment variables on cutaneous leishmaniasis occurrence using time-series models and compare the predictive ability of seasonal autoregressive integrated moving average (SARIMA) models and Markov switching model (MSM). Methods: This descriptive study employed yearly and monthly data of 49 364 parasitologically-confirmed cases of cutaneous leishmaniasis in Isfahan province, located in the center of Iran from January 2000 to December 2019. The data were provided by the leishmaniasis national surveillance system, the meteorological organization of Isfahan province, and Iranian Space Agency for vegetation information. The SARIMA and MSM models were implemented to examine the environmental factors of cutaneous leishmaniasis epidemics. Results: The minimum relative humidity, maximum relative humidity, minimum wind speed, and maximum wind speed were significantly associated with cutaneous leishmaniasis epidemics in different lags (P

Background: Acute leukemia is a kind of aggressive disease that includes high rates of fatalities in the world, in particular in Iran. This research was done to determine the survival rate of patients with acute leukemia in Iran. Methods: 85 adult patients who were first diagnosed with acute leukemia in Shahid Bahonar hospital of Kerman during March 2012 until March 2013 were evaluated in a retrospective descriptive study to measure the death/life status in a 5-year period (2012-2017). The required data was gathered from medical records of patients, HIS system data, and the cancer registry system, and the Kaplan-Meier estimator and Log Rank test were used to calculate the survival rate using SPSS23. Results: Survival rate was completely 45.9 % for patients with acute adult leukemia. It was 47.08 % in acute myelogenous leukemia (AML) and it was 43.06 % in acute lymphocytic leukemia (ALL). The 1,2,3,4 and 5-year survival of acute leukemia was respectively 87.1 %, 69.4 %, 62.4 %, 56.5 % and 45.9 %. Conclusion: Iran's health system should design and plan to increase the survival of patients with acute leukemia by improving the methods and facilities to diagnose and treat it more quickly and more effectively.

Introduction: The purpose of this systematic review was investigating the implementation outcomes of the diagnosis-related groups. Methods: In this study, articles evaluating the effect of DRG impl...

Objectives: We assessed the epidemiological and spatiotemporal patterns of HIV cases reported between 1997 and 2020 in Kerman, Iran. Method: We compared the age, gender, modes of transmission, and spatial distribution of newly diagnosed HIV infected people over time (1997-2004, 2005-2012, and 2013-2020). We also mapped the services and spatial distribution for people who were living with HIV in 2020. The nearest neighbor index and kernel density were used to identify the spatial distribution of HIV cases. Chi square for trend, one-sample t-test, and Kruskal Wallis H tests were used to compare the differences over time. Stata 17 and ArcGIS 10.3 were used for HIV surveillance data analysis. Results: A total of 459 (25.6% women) people were diagnosed with HIV during 1997-2020. The proportion of women (from 9.3% in 1997-2004 to 48.3% in 2013-2020, P < 0.001), those infected with HIV through sexual contacts (from 11.6% in 1997-2004 to 50.3% in 2013-2020, P < 0.001), proportion of HIV infected children under 5 years of age (0.8% in 1997-2004 to 5.4% in 2013-2020, P = 0.01), and mean age at diagnosis among men (from 34.9 in 1997-2004 to 39.8 years in 2013-2020, P = 0.004) significantly increased over time. The mean age at diagnosis among women (34.5 years in 2013-2020), and the proportion who diagnosed with CD4 count

Vaccination is an essential way to prevent the transmission of hepatitis B virus (HBV). Various studies have been published on the cost-effectiveness of HBV vaccination, but since the results vary according to the target population and related health outcomes, this study examined the cost-effectiveness of the universal HBV vaccination in Iran. In this economic evaluation study, a decision tree with the Markov model was used to compare the universal HBV vaccination with a strategy of non-vaccination. Health states used in the model included healthy, chronic hepatitis B, compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and death. Analyses were performed from a payer's perspective. Incremental cost-effectiveness ratio (ICER) per life-year gained, and quality-adjusted life-years (QALYs) gained were calculated at a 5% annual discount rate. The sensitivity analysis was conducted using Monte Carlo simulation. Analyses were performed using Microsoft Excel and TreeAge Pro 2011 software. In 2017, the estimated cost per dose for any HBV vaccine was $3.20 USD. The universal HBV vaccination was economically advantageous compared to non-vaccination, and the estimated cost of this program per life-year and QALY gained were $6,319 and negative (-) $1,183.85 USD, respectively. Given the uncertainty of all parameters, the model remained robust and reliable. In Iran, the universal HBV vaccination strategy for both health outcomes of QALY and life-years gained was cost-effective and advantageous. The vaccination strategy saved money, increased life years and improved quality of life. Therefore, it is recommended that this program continues to be provided.

Background The novel Coronavirus disease 2019 (COVID-19) rapidly became the world’s largest threat to health and the economy in recent times. Prediction of the COVID-19 pandemic’s full impact is a necessary gauge for future policy making, including resource allocation for prevention, mitigation, and control preparedness.Methods We used the extended form of the Susceptible-Exposed-Infected/Infectious-Recovered/Removed (SEIR) model to predict new cases and number of deaths associated to COVID-19. Data from the Ministry of Health and Medical Education of Iran provided relevant parameters for predicting disability-adjusted life years (DALYs). We conducted a review of the literature on COVID-19-like diseases to develop disability weights (DWs) and convened an expert panel to verify their applicability. Beta-PERT distributions were used to calculate DWs for age groups. The minimum and maximum values were 0 and 0.14 for mild to severe disability, respectively.Results The total DALYs for COVID-19 in Iran predicted by our model will be 973 per 100,000 populations from January, 2020 to January, 2021. Overall, 957 years per 100,000 will be from YLLs (98.4% of DALYs) and 16 will be from YLDs (1.6% of DALY). The total DALYs in men will be 1,082 years per 100,000 and 861 per 100,000 in women.Conclusions Our predictions of COVID-19 burden will be useful in determining health priorities and to appropriately allocate resources to prepare for future outbreaks of COVID-19 and similar diseases. We hope this study will contribute to evidence-based health policy making in Iran.

Background Health costs have increased significantly around the world, and cost assessments have become important. This study aimed to collect cost of the resources used in the national hepatitis B immunization program in Southern Iran. Methods Costs were calculated by investigating the available documents as well as consulting with knowledgeable personnel. These costs were collected using the data from Shiraz University of Medical Sciences. According to the health payer’s perspective, the indirect costs of the people were not taken into account. All current and capital costs in year 2017 were calculated and converted to US dollars (USDs). Results In 2017, 33 204 children received hepatitis B vaccine. The total cost of the national hepatitis B vaccination program in Shiraz and the cost of vaccination per child were 473 506 and 14.26 USD, respectively. However, the cost of inoculation of hepatitis B vaccine per dose was estimated at 3.20 USD. Personnel costs constituted the highest proportion (53.84%) of total costs. Conclusions The cost of hepatitis B vaccination in Iran was lower than other countries. Considering that personnel costs had the largest proportion, it is recommended that proper measures be taken to monitor and modify these costs if necessary.

Assisted reproductive technologies (ARTs) are often considered luxury services by policy-makers and the general population, which are always susceptible of removal from public funding of health care. The analysis of the economic aspects of this scope seems essential due to the high prevalence of infertility in Iran and the high costs of infertility treatments. This study aimed to investigate the value put on IUI and IVF treatments by communities in Iran and the affordability of services based on community preferences. A cost-benefit analysis (CBA) was performed based on the WTP approach, and the contingent valuation method (CVM) was used to estimate WTP for IUI and IVF using a researcher-made survey in two cities of Kerman and Isfahan, Iran, in 2016-17. The sample size was 604, and the study sample frame to estimate WTP included two groups of couples who were/were not aware of their fertility statuses. The costs of one cycle of IUI and IVF were calculated according to the treatment protocols, tariffs of 2016-17, and medical information records of patients. The mean direct and indirect medical costs of one cycle of IUI and IVF were equivalent to 19561140 and 60897610 IRR, respectively. Also, the mean WTP for IUI and IVF treatments were obtained of 15941061 and 28870833 IRR, respectively. The demand for IUI and IVF treatments was elastic and the community was sensitive to price changes of these treatment methods. IUI and IVF treatments brought no positive net benefits, and economic variables had the highest impact on the WTP and community preferences, indicating the significant role of financial constraints in the community's valuation for advanced infertility treatments in Iran.

Background: Clinical laboratories need to manage resources properly and scientifically to survive in today's highly competitive environment. In this context, scientific-economic principles should be considered to determine the profitability or loss of laboratories. Thus, in this study, the net profit of laboratory services was measured based on scientific-economic principles. Methods: This was an applied research with descriptive-retrospective approach. A laboratory was selected from 61 laboratories of Kerman, Iran, which performed the highest number of tests among the laboratories of this city. In addition, due to easy access, it was the most visited laboratory by patients. The present study had 2 main phases: (1) measuring the price of services and (2) calculating the net profit of the studied laboratory. Data analysis was performed using activity- based costing (ABC) as an econometric model and Excel software. Results: The highest charges were related to direct costs (78.28%); consumable goods (47.26%) and professional and logistic human resources (46.31%) had the highest share of these costs. In the test groups, the most expensive tests belonged to the hormones (23.03%) and clinical chemistry (20.84%). Total cost, revenue, and the net profit of the studied laboratory were 641 645, 1 390 942, and 749 297 USD, respectively. After doing sensitivity analysis (50% increase in the frequency of tests), the following values were obtained: 987 071, 2 086 413, and 1 099 342, respectively. Conclusion: Some test groups in the studied laboratory were not profitable, and this was due to the high cost of these tests and illogical tariffs. One way to overcome this problem is to increase the frequency of laboratory tests.

Background: One way to improve the performance of hospitals, the largest resource-consuming units in the healthcare sector, is to continuously evaluate their performance.Objective: The current study assessed the performance of hospitals affiliated with the Kurdistan University of Medical Sciences using data envelopment analysis (DEA).Methods: This retrospective descriptive-analytic study used DEA to assess efficiency types (technical, managerial, and scale) in hospitals of the Kurdistan University of Medical Sciences (n = 12) in the years 2007 to 2011. The number of active beds, nurses, physicians (general and specialist), and other staff were inputs; inpatient admission and occupied bed days were outputs. Stata version 12 was used for data analysis.Results: The mean technical, scale, and managerial efficiency values were 0.85, 0.89, and 0.95, respectively. The highest and lowest slack inputs were nurses and active beds, respectively.Conclusion: The findings indicate that Kurdistan hospitals were less than appropriately efficient during the studied period. They also suggest that there is a capacity of about 15% for enhancing output in hospitals (compared with the most efficient studied hospitals) without increasing costs or inputs.

Background: Cardiovascular Disease (CVD) is one of the major concerns all around the world. It is caused by mass of atherosclerotic plaques in the walls of coronary arteries, which ends in narrowing of veins, heart failure, angina, and Myocardial Infarction (MI). The growing need for therapeutic interventions in CVD patients illustrates the importance of paying special attention to these patients’ Quality of Life (QoL) and the vital interventions for their treatment. Objectives: This research aimed to evaluate patients’ QoL after Coronary Artery Bypass Grafting (CABG) and Percutaneous Coronary Intervention (PCI) using Seattle Angina Questionnaire (SAQ) and Short Form-36 (SF-36). Patients and Methods: This six-month cohort study aimed to evaluate the QoL among CAD patients in Shiraz, Iran via SAQ and SF-36. The study population included all the patients who had undergone CABG and PCI in the hospitals of Shiraz University of Medical Sciences from May to December 2014. A total of 200 patients were selected for each intervention. After gaining the patients’ consent to take part in the research, 200 patients who applied for CABG and 198 patients who applied for PCI agreed to participate in the study. Pre-intervention data were gathered through a demographic data form and two valid and reliable questionnaires for QoL. The post-intervention data were also gathered six months after the treatment using the same questionnaires. Then, the data were entered in to the SPSS statistical software, version 20 and were analyzed using paired sample t-test, Kruskal-Wallis, Mann-Whitney U, ANOVA, and Spearman and Pearson correlation coefficient. Results: Intervention was proved to be the most effective factor in changing the patients’ QoL (P = 0.04, mean ± SD = 4.65 ± 22.02 for PCI and 8.25 ± 22.97 for CABG using SF36; P = 0.002, mean ± SD = 10.54 ± 17.14 for PCI and 15.47 ± 16.81 for CABG using SAQ). Moreover, both intervention types boosted the patients’ QoL (P < 0.001). However, CABG appeared to be more successful in boosting the QoL compared to PCI. Additionally, although CABG did notexert any significant effects on the score of physical limitation (P = 0.74), it had impacts on all the features of SAQ.

In health insurance, a reimbursement mechanism refers to a method of third-party repayment to offset the use of medical services and equipment. This systematic review aimed to identify challenges and adverse outcomes generated by the implementation of reimbursement mechanisms based on the diagnosis-related group (DRG) classification system. All articles published between 1983 and 2017 and indexed in various databases were reviewed. Of the 1,475 articles identified, 36 were relevant and were included in the analysis. Overall, the most frequent challenges were increased costs (especially for severe diseases and specialised services), a lack of adequate supervision and technical infrastructure and the complexity of the method. Adverse outcomes included reduced length of patient stay, early patient discharge, decreased admissions, increased re-admissions and reduced services. Moreover, DRG-based reimbursement mechanisms often resulted in the referral of patients to other institutions, thus transferring costs to other sectors.Keywords: Health Insurance; Third-Party Payments; Reimbursement Mechanisms; Diagnosis-Related Groups; Quality of Health Care; Patient Outcome Assessment; Systematic Review.

PurposeHigh quality healthcare is important to all patients. If healthcare is felt to be high quality, then patients will be satisfied, and the relationship between patients and healthcare providers will improve. Patient satisfaction is among the most commonly used service quality indicators; however, it is not fully known which factors influence satisfaction. Therefore, it is necessary to pay attention to the elements that affect both healthcare quality and patient satisfaction. Nowadays, several methods are used in health economics to assess patient preferences, prioritize them and help health policy makers improve services. Discrete choice experiment (DCE) is one method that is useful to elicit patient preferences regarding healthcare services. The purpose of this paper is to apply DCE and elicit patient preferences in medical centers to rank certain healthcare quality factors.Design/methodology/approachThe descriptive, analytical study used a cross-sectional questionnaire that the authors developed. In total, 12 scenarios were chosen after applying fractional factorials. The questionnaire was completed by patients who were admitted to Kerman General Teaching Hospitals, South-East Iran in 2015. Patient preferences were identified by calculating the characteristics’ marginal effects and prioritizing them. The generalized estimation equation (GEE) model was used to determine attribute effects on patient preferences.FindingsIn total, 167 patients completed the questionnaire. Prioritizing the attributes showed that “physical examination” was the most important attribute. Other key features included “cleanliness,” “training after discharging,” “medical staff attention,” “waiting for admission” and “staff attitude.” All attributes were statistically significant (pPractical implicationsTo increase hospital patient satisfaction, health policy makers should develop programs to enhance healthcare quality and hospital safety by increasing physical examination quality and other services.Originality/valueTo estimate DCE independent variables, logistic regression models are usually used. The authors used the GEE model to estimate discrete choice experiment owing the explanatory variables’ dependency.

Background: Adherence to screening services is a prerequisite for the success of screening programs. Objectives: This study aimed at determining factors associated with participants’ compliance with Dual-energy X-ray Absorptiometry (DXA) screening for osteoporosis. Methods: In this population-based participatory study, 1000 males and females older than 55 years old were invited to participate in the study. The study took place in the city of Kerman, Iran, where subjects were informed face to face about the risk factors and complications of osteoporosis and asked to complete a questionnaire. The subjects were then invited to visit a densitometry center for a free DXA study. Four rural areas and 4 locations in Kerman were selected based on municipal divisions. Results: A total of 923 individuals completed the questionnaire: 562 (60.9%) were female, nearly two-thirds were from urban areas, and 284 (30.8%) were willing to undergo densitometry. Eight percent had a history of corticosteroid use for more than 3 months. About two-thirds of the participants were walking less than 150 minutes per week. In the logistic regression analysis, urban residents (OR = 1.88), females (OR = 1.52), and those who perceived high risk of osteoporosis (OR = 1.67) were more likely to adhere to DXA screening. Conclusions: On the whole, despite informing people about osteoporosis and offering free services, compliance to densitometry was not remarkable.

Background Mammography screening is a method for reducing breast cancer mortality in women over 40 years old . A participation rate of at least 70% is a prerequisite for screening programs. This study aimed at determining the participation rate of women in breast cancer screening in Iran. Materials and methods The study population in this prospective research consisted of 35 to 69 years old women in the villages and towns Kerman District, in 2013. The data were collected by a well-validated risk assessment questionnaire. The questionnaires were completed with the help of health workers and technicians in the health centers, who were trained on breast cancer screening program. Results As a whole, 19,651 women were invited to complete the questionnaire, of whom 15,794 women (80.37%) completed it. In the urban region, of 3150 eligible women 2728 women (86.60%) participated in the study. The acceptance rates for mammography in rural and urban regions were 34.95% and 8.75%, respectively. Conclusions Finally, 3.8% and 16.34% of 35 to 69 years old women in the urban regions were mammographed, respectively. Conclusion The low participation of eligible women in breast cancer screening program alerts us against including the program in the health insurance package.

Background: In evaluating the activities and performance of radiology units, the main aim of applying feasible scientific methods is to use technological and human resources optimally. One of the suitable scientific methods in this field is determining the technical, economic, and allocative efficacy of these centers. We aimed to assess the economic efficiency of radiology units of hospitals affiliated to Shiraz University of Medical Sciences, southern Iran. Methods: In this descriptive-analytical cross-sectional study, the technical, economical, and allocative efficiency of 27 radiology units of public hospitals was assessed using data envelopment analysis. The input oriented envelopment form with the assumption of the varied outputs with respect to the scale was used. Related forms were filled using the existing information in the archives of radiology centers. Input variables in this study were the number of radiology devices, the number of expert personnel, the number of technicians, equipment maintenance and depreciation costs, and the salaries of the experts and technician. Output variables included the number of admitted patients and the number of photographic film. Then, data were analyzed using the DEAP software for calculating the various forms of efficiency. Results: The mean scores of economic, technical, and allocative efficiencies of radiology units were 0.749, 0.880, and 0.852, respectively. The final score of economical efficiency was lower than the technical and allocative efficiency scores. Only 15% of radiology units were economically efficient. Conclusion: Economical efficiency can be attained when resources are used in the best possible way and not wasted. Therefore, a combination of inputs that comprise the lowest costs should be selected.

Introduction: During the last decade, the health sector of many countries in general has been faced significantly with the increase of health care costs and in particular with the growth in hospital costs, that a significant part of it is due to the inefficient use of resources. The present study has been calculated the technical efficiency of the Specialty Ophthalmology Hospital of Tehran University of Medical Sciences by the comprehensive data analysis methods and stochastic frontier analysis. Methods: In this article, the technical efficiency of the Specialty Ophthalmology Hospital of Tehran University of Medical Sciences has been calculated by the years of 2009 to 2011, by the comprehensive data analysis methods and stochastic frontier analysis. For this purpose, the form of input-oriented data envelopment analysis approach was used by assuming the variable Productivity to scale and stochastic frontier analysis method and from the five output, the occupied bed days, outpatient admissions, inpatient admissions, inpatient days and bed occupancy factor, and from the six output, it means active beds, number of doctors, nurses, and other personnel, budget and equipment costs were used for the study. For data analyzing, Deap software, edit 1/2 and Frontier edit 1/4, was used. Result: The results of a comprehensive data analysis method showed: 1) The capacity of improving technical efficiency in the studied sector is 34% (average technical efficiency is 0.663 parts); and 2) some of the sectors are met the excess inputs (factors of production). Technical efficiency using stochastic frontier analysis was equal to 0.937. In fact, the stochastic frontier analysis showed the inefficiency is less than the actual value. Conclusion: Reducing excess capacity factors (factors of production) should be conducted in the form of a comprehensive plan and by considering all regarded aspects, that this reduction plays a major role in the hospital and health sector costs reduction.

Background Due to the importance and uniqueness of the characteristics of the health sector, one of the most important priorities of the Ministry of Health is measuring the efficiency and quality of services which are provided for the people who refer to the health sectors. In all health systems, responding to the needs and wishes of patients is a crucial priority. Objectives The main purpose of this study is to prioritize the features of the services from the perspective of patients, by applying the Logit model. Materials and Methods This study is a descriptive cross-sectional study and in terms of results it can be classified to an applied study. Data were collected by a questionnaire filled by 330 patients in Imam Khomeini hospital, and for estimating the utility function the software STATA version 10 was applied. In this study the preferences of patients who admitted to hospitals were identified by calculating the marginal utility of the characteristics, where we also used Marginal Rate substitutions (MRS). Results Determination of the marginal utility characteristics shows that the first priority in receiving hospital services is the type of examination, and the last priority in the cleaning service of the sections and restrooms . Waiting time between hospital arrivals and admission has a negative sign which indicates a negative impact on patient preference. Conclusions The results of this study are consistent with studies by Kara Hanson and Barbara Mc Clean, where in their study they also showed that by the patient’s perspective, hospital examination is the most important quality characteristic (coefficient = 2.78). In other words, the ultimate purpose of the hospital visit is the quality of service and examination, where many patients are willing to wait longer or pay higher costs to get the best services.

Background: Hospitals are the most costly and important components of any health care system, so it is important to know their economic values, pay attention to their efficiency and consider factors affecting them. Objective: The aim of this study was to assess the technical scale and economic efficiency of hospitals in the West Azerbaijan province of Iran, for which Data Envelopment Analysis (DEA) was used to propose a model for operational budgeting. Materials and Methods: This study was a descriptive-analysis that was conducted in 2009 and had three inputs and two outputs. Deap2, 1 software was used for data analysis. Slack and radial movements and surplus of inputs were calculated for selected hospitals. Finally, a model was proposed for performance-based budgeting of hospitals and health sectors using the DEA technique. Results: The average scores of technical efficiency, pure technical efficiency (managerial efficiency) and scale efficiency of hospitals were 0.584, 0.782 and 0.771, respectively. In other words the capacity of efficiency promotion in hospitals without any increase in costs and with the same amount of inputs was about 41.5%. Only four hospitals among all hospitals had the maximum level of technical efficiency. Moreover, surplus production factors were evident in these hospitals. Conclusions: Reduction of surplus production factors through comprehensive planning based on the results of the Data Envelopment Analysis can play a major role in cost reduction of hospitals and health sectors. In hospitals with a technical efficiency score of less than one, the original and projected values of inputs were different; resulting in a surplus. Hence, these hospitals should reduce their values of inputs to achieve maximum efficiency and optimal performance. The results of this method was applied to hospitals a benchmark for making decisions about resource allocation; linking budgets to performance results; and controlling and improving hospitals performance.

Background: Leukemia and lymphoma demonstrate significantly incidence rates throughout the world and particularly in Iran they cause serious mortality and diagnosis and treatment expenditures for both families and the health system. Combined they account for about 11 percent of cancers in Mazandaran province, ranking number 2 in prevalent cancers. The purpose of this study was to provide a first general and specific description of leukemia and lymphoma in Mazandaran province. Materials and Methods: In this descriptive retrospective study, entire patient’s data were reviewed which had confirmed diagnosis of leukemia and lymphoma with valid laboratory or pathology reports in the period 2001-2008. The data were collected by Babol health research site related to Tehran University of Medical Science. Incidence rates based on age groups, gender, city of residence and type of malignancy were calculated and analyzed. Results: In Mazandaran province, 1,146 cases of leukemia and lymphoma were encountered, 5.9 in 100,000 persons on average annually. The highest incidence rates were obtained at age of 70 or above (26.4) and the lowest at age of 0-9 (2.3).The incidence rates in males and females were 7.1 and 4.8 respectively with a ratio of 1.5. The highest incidence rate was in Babol (7.3) and the lowest was calculated in Neka and Tonekabon equally (1.5). According to the type of malignancy, non Hodgkin lymphoma, with 2.5/100,000 have the most incidence rate and myeloid leukemia with 1.8 had the lowest. Conclusions: The obtained findings indicate clear differences in incidence rates based on age, gender, residence, and type of malignancy. Therefore it’s suggested that in addition to promote data collecting programs, research projects should be programmed to define leukemia and lymphoma risk factors in this province.

Background: Mapping from non-performance-based measures onto generic performance-based measures provides an appropriate solution to derive utilities to be used in economic evaluations. Objectives: This study aimed to create a model through which EQ-5D utilities for cataracts can be obtained from scores on the diseasespecific Catquest measure. Patients and Methods: One hundred ninety-nine observations from 103 patients who self-administered the EQ-5D, the Catquest and questions on demographic and clinical characteristics were included in the analysis. Data was divided into estimation and validation datasets. To predict EQ-5D utilities, multiple regression analysis, using the Ordinary Least Square (OLS) and the censored least absolute deviation (CLAD), was performed. Catquest scores, age, gender, and performing surgery were included as explanatory variables. An estimation dataset was used to derive the coefficients, and these coefficients were then validated using a validation dataset. Based on the explanatory power, the consistency, the simplicity, the mean absolute error (MAE) and the correlations between observed and fitted utilities, the most appropriate model was selected. Results: The mean EQ-5D and Catquest scores of the total sample were 0.631 and 15.8, respectively. Age and surgery showed no significant effect for either method. Removing age and surgery, model II was built and given an R 2 of 0.697, an MAE of 0.1176 for the OLS and an R 2 of 0.614, and an MAE of 0.1153 for the CLAD method. In the validation stage, the CLAD revealed better prediction ability, with an MAE of 0.198 versus an MAE of 0.209 for the OLS. ICC and Bland-Altman analysis put the CLAD as a preferred method with the following equation: Utilities (EQ-5D) = 0.988 - 0.0281 × Catquest (PD) + 0.102 × gender (male = 1). Conclusions: Based on these results, a mapping function was obtained which appears to be valuable in predicting EQ-5D utilities from Catquest scores. This function gives an appropriate solution to estimate utilities when primary EQ-5D data is not available. Although the model represents good consistency and predictive ability, further examination of obtained function is required with large samples.

Economic decision models are being increasingly used to assess medical interventions. Advances in this field are mainly due to enhanced processing capacity of computers, availability of specific software to perform the necessary tasks, and refined mathematical techniques. We here estimated the incremental cost-effectiveness of ten strategies for colon cancer screening, as well as no screening, incorporating quality of life, noncompliance and data on the costs and profit of chemotherapy in Iran. We used a Markov model to measure the costs and quality-adjusted life expectancy of a 50-year-old average-risk Iranian without screening and with screening by each test. In this paper, we tested the model with data from the Ministry of Health and published literature. We considered costs from the perspective of a health insurance organization, with inflation to 2011, the Iranian Rial being converted into US dollars. We focused on three tests for the 10 strategies considered currently being used for population screening in some Iranians provinces (Kerman, Golestan Mazandaran, Ardabil, and Tehran): low-sensitivity guaiac fecal occult blood test, performed annually; fecal immunochemical test, performed annually; and colonoscopy, performed every 10 years. These strategies reduced the incidence of colorectal cancer by 39%, 60% and 76%, and mortality by 50%, 69% and 78%, respectively, compared with no screening. These approaches generated ICER (incremental cost-effectiveness ratios) of $9067, $654 and $8700 per QALY (quality-adjusted life year), respectively. Sensitivity analyses were conducted to assess the influence of various scales on the economic evaluation of screening. The results were sensitive to probabilistic sensitivity analysis. Colonoscopy every ten years yielded the greatest net health value. Screening for colon cancer is economical and cost-effective over conventional levels of WTP8.

Breast cancer is one the most common cause of cancer-related deaths among women worldwide. The aims of this study were to investigate the impact of dietary factors and health status indicators on breast cancer (BC) incidence.Risk factor data (RFD) of 89,404 individuals (15-64 years old) were gathered by questionnaire and laboratory examinations through a cross sectional study from the Non- Communicable Disease Surveillance Centre (NCDSC) of Iran. BC incidences of all provinces through 2001-2006 segregated by age and gender were obtained from the Cancer Registry Ministry of Health (CRMH).A significant positive relationship was seen between diabetes mellitus, fish consumption, percent of academic education and non-consumption of fruit, and breast cancer in women. However, non fish consumption, percent age illiteracy and taking fruit showed a significant negative relationship with the incidence of breast cancer. In addition, multiple linear regression analysis showed associations among percentage with academic education, fruit consumption and diabetes.We conclude that dietary factors such as fish and fruit consumption, dairy products, health status indicators, academic education, and some diseases like diabetes mellitus can affect the BC incidence, although the results of ecologic studies like this must naturally be interpreted with caution.

Given the growing importance and role of drugs in the treatment of diseases, as well as replacement of them rather than expensive and often unsafe procedures, study of socioeconomicfactors affecting future demand for them seems necessary.we seek to examine the extent of to which socioeconomic factors affect specialty medicine use by the patients.using data from questionnaires completed by 280 patients with multiple sclerosis, hemophilia, thalassemia, and chronic kidney disease, we estimate marginal effect of significant variables in probit model.We found that the need for the patient(ME = 0.858), deterioration of the patient (ME = -0.001), household size (ME = 0.0004), House Ownership (ME = -0.002), gender (ME = -0.04), income (ME = -0.0007), education (ME = -0.0021) and job (ME = -0.0021) are significant variables affecting demand for specialty drugs. We conclude that it can be programmed to promote and protect the welfare of patients by specific factors such as income, and largely affect the demand of medication and medical services. Therefore economic aid to these patients should not be limited only to medical subsidies, especially in patients with MS, income and welfare can reduce drug demand.

Introduction: Adequate information about patient using health care facilities is a critical element in planning activities and allocation resources in health sector. In Iran, with performing family physician plan and attempt to reform referral system, the study of mobility of patients between regions (patient migration) has more importance. The aims of the study are: 1) to describe patients’ migration across cities of Iranian Kerman province; 2) to analyze the role of possible determinants affecting the mobility flows. Methodology: using hospital inpatient records of all public hospitals around Kerman province during 2011, we run logit models that compare patients who were admitted in hospital and received health services in cities where they lived and patients received them out of their local hospitals. We studied 21 patient groups according to ICD10 chapters (Appendix 1) to compute the effect of geographic distance, kind of insurance, number of physiccians involved, hospital bed and patient demographic factors. Results: About 40 percent of hospital admissions in Kerman are emigrant patients that quality or quantity of local provided services didn’t satisfy. Constant negative coefficients of geographic distance, hospitals physician and bed and positive coefficients for insurance in all groups do not show any difference in patient migration, between groups. Discussion: According to results of this research, existence of local services, distance, kind of illness and other factors are not more important than patients’ feeling about services in their migration. Paying no attention to this reality in planning health system reforms, especially referral systems, leads to important problems for health system in equity, patient satisfaction and finance aspects.

BACKGROUND Given increasing rates of colorectal cancer (CRC) in countries with intermediate incidence rates, the decision to implement population-based screening must consider the trade-off between high costs and a relatively low yield. We estimated the incremental cost-effectiveness ratio of 10 strategies for colorectal cancer screening, as well as no screening, incorporating quality of life, noncompliance, and data on the costs and benefits of chemotherapy in Iran. METHODS We used a Markov model to measure the costs and quality-adjusted life expectancy of 50-year-old average-risk Iranian without screening and with screening by each test. In this study, we populated the model with data from the ministry of health and published literature. We considered costs from the perspective of a health insurance organization, with inflation to the 2011 Iranian Rial converted to US dollars. We focused on three tests of the 10 strategies considered, currently being used for population screening in some Iranian provinces (Mazandaran Kerman, Golestan, Ardabil, and Tehran): low-sensitivity guaiac fecal occult blood test, performed annually; fecal immunochemical test, performed annually; and colonoscopy, performed every 10 years. RESULTS These strategies reduced the incidence of colorectal cancer by 39%, 60%, and 76% and mortality by 50%, 69%, and 78%, respectively, compared with no screening. These strategies generated ICER (incremental cost-effectiveness ratios) of $9067, $654, and $8700 per QALY (quality-adjusted life year), respectively. Sensitivity analyses were performed to evaluate the influence of various parameters on the cost-effectiveness of screening. The results were robust to probabilistic sensitivity analysis. Colonoscopy every 10 years yielded the greatest net health benefit. CONCLUSIONS Screening for colorectal cancer is cost-effective over conventional levels of WTP (Willingness to Pay). Annual high-sensitivity fecal occult blood testing, such as a fecal immunochemical test, or colonoscopy every 10 years offer the best value for the money in Iran.

INTRODUCTION: Infertility affects both women and men in all the countries. Infertility often has profound long-term or short-term impacts on the people involved and puts them at risk of familial and social pressures. According to WHO estimates, between 8% and 12% of all the couples worldwide experience some form of infertility during their reproductive life, i.e. 50‒80 million people are affected. The aim of this study was to evaluate the response to infertility treatment by taking into account factors such as age, hirsutism, menstruation and galactose among women in Kerman. METHODOLOGY: Of a total of 300 patient files evaluated 220 cases were flawless, of which the study factors were recorded. These data were estimated by Logit model. The dependent variable was the response to treatment (0 and 1) and the independent variables included age of men and women, hirsutism, menstruation, galactose, duration of the period no preventive measures were used and body mass index. After entering the data, model output was analyzed by using the STATA software. RESULTS: The results showed that of all the model variables, female age (prob=0.0065), menstruation (prob=0.04), hirsutism (prob=0.02), marriage age (in months) (prob=0.02) and BMI were significant and other variables were not significant. McFadden analysis for goodness of fit was 0.92. CONCLUSION: The study results showed that women should pay more attention to variables such as BMI, menstruation quality (regular and irregular) and aging because clinical disregard of any of the above can have a significant impact on the individual’s fertility.