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Abstract Background Diabetes mellitus, particularly Type 2 diabetes (T2D), represents a significant global health challenge, with its prevalence steadily rising over the past few decades. This study was conducted with the aim of estimating the economic burden of T2D in Iran. Methods This study employed a prevalence-based approach to estimate the economic burden of T2D and its attributable complications in adults above 20 years old in Iran for 2022. Both direct medical costs and indirect costs were considered in our analysis. Direct medical costs included inpatient and outpatient costs attributable to T2D and its complications, while indirect costs encompassed absenteeism, presenteeism, inability to work, and premature mortality costs due to the disease. Results The findings showed that a total of 5,702,547 people, equivalent to 14.2% of Iranian adults, had T2D. The estimated total direct medical cost of T2D and its attributable complications in Iran in 2022 was 1,879.2 million US dollars (US$-PPP 6,676.9 million). Chronic kidney disease accounted for the largest proportion, followed by ischemic heart disease (IHD), and T2D itself. The total economic burden of T2D and its attributable complications in Iran in 2022, was estimated to be $2,905.7 million US dollars (US$-PPP 10,324.2 million). The direct medical cost constituted the majority of the economic burden (64.7%), while the inability to work due to these health conditions also contributes significantly (28.6%). Absenteeism (2.9%), presenteeism (1.7%), and premature mortality (2.2%) make up smaller proportions of the overall economic impact of T2D and its complications in Iran during that year. Conclusion Our study highlights the significant and diverse economic impact of T2D and its complications in Iran. This burden encompasses not only healthcare-related expenses but also negative impacts on society and productivity, as well as the occurrence of early death. To successfully address this burden, a comprehensive strategy is needed, which includes programs to prevent diabetes, better access to healthcare services, and increased social support for individuals with this long-term condition.

Abstract Background The burden of disease based on disability-adjusted life years (DALYs) is one of the internationally accepted metrics for assessing the impact of a disease or injury on population health. This study aimed to provide evidence of the burden of COVID-19 on health in Iran based on hospital-level data from the Iran Health Insurance Organization (IHIO), which covers almost half of the country’s population. Methods The data of all IHIO enrollees who were referred to hospitals across the country from the beginning of the COVID-19 pandemic (February 2020) to December 30, 2021, with assigned diagnosis codes of COVID-19, were extracted from the hospital information processing system. The DALYs due to COVID-19 were estimated using the standard approach of the World Health Organization and the European Burden of Disease Network guideline. Results In the years 2020 and 2021, among a population of about 42 million people, 1,040,367 individuals were admitted to the hospital due to COVID-19 infection, of whom 73% were hospitalized (760,963 patients). The total estimated DALYs for these two years were 665,823 and 928,393, respectively (1,603 and 2,234 per 100,000 population). 99.7% of DALYs were attributed to years of life lost due to premature death (YLLs). The share of the disease burden in the age groups of under 20 years, 20–49 years, 50–80 years, and over 80 years was 6.6%, 26.4%, 58.4%, and 8.6%, respectively. Conclusions Based on the hospital-level data estimates, COVID-19 has had a significant burden on health in Iran. COVID-19 was identified as the fifth leading cause of disease burden in Iran during the study period, ranking after cardiovascular diseases, psychological disorders, neoplasms, and musculoskeletal disorders. Additionally, COVID-19 was the third major cause of death, following cardiovascular diseases and neoplasms. Policymaking and the implementation of comprehensive programs to enhance the response of the health system and society to outbreaks of emerging and re-emerging infectious diseases are of utmost importance.

Background: With the rising burden of cardiovascular disease (CVD) and the need for cost-effective interventions, evaluating the economic implications of Evolocumab becomes crucial. Objectives: This study aimed to systematically review and evaluate the cost-effectiveness of Evolocumab in adults at risk of CVD. Methods: We performed an extensive search in Cochrane Library, EMBASE, PubMed, ProQuest, and Web of Science. The reference lists of chosen literature reviews were also examined to find suitable cost-effectiveness analyses (CEAs) of Evolocumab in patients with CVD published until March 2023. The Consolidated Health Economic Evaluation Reporting Standards statement (CHEERS) was used to assess the reporting quality. Cost-related findings were adjusted to reflect 2023 purchase power parity (PPP) values in US dollars to enable cross-study comparisons. Results: This systematic review comprised 16 studies, published between 2016 and 2023, mostly from the USA and China. Compliance with the CHEERS checklist was high in sections like abstracts, backgrounds, and objectives. However, areas like perspective (71.4%), time horizon (57.1%), and engagement with patients (14.3%) showed lower reporting rates. All studies evaluated the cost-effectiveness of Evolocumab in combination with other lipid-lowering treatments (LLTs). Notably, all studies employed model-based economic evaluations using a Markov cohort state-transition model, with a majority adopting a lifetime horizon. Most studies (10 cases) simultaneously reported both the Incremental Cost-Effectiveness Ratio (ICER) per Quality Adjusted Life Years (QALY) and the ICER per Life-Years Saved (LYS). Four studies exclusively reported ICER/QALY, and 2 studies solely focused on ICER/LYS. The ICER/ QALY exhibited a wide range (3,342.57 to 2,687,920.13 USD), with one study presenting as an outlier. Sensitivity analyses revealed factors influencing cost-effectiveness outcomes, including Low-Density Lipoprotein Cholesterol (LDL-C) levels, Evolocumab costs, and disease type, while several studies reported accepted thresholds for cost-effectiveness analysis. Conclusions: Our systematic review concludes that Evolocumab could be a cost-effective treatment, particularly for high-risk patient groups, but this varies by disease category, risk level, and evaluation methods. Future studies should investigate the economic impact's certainty and uncertainty, and consider different countries' income levels. LDL-C levels, medication costs, and CVD types are important factors affecting cost-effectiveness analysis.