Rahil Sadat Shahtaheri; Shekoufeh Nikfar; Elahe Khorasani; Mansoureh Sabbagh-Baniazad; Zahra Goudarzi; Maziar Emamikhah
Abstract
Background: Although widely used, first-line injectable medicines for the treatment of multiple sclerosis (MS) remain an issue of efficacy and adherence. Recently, new oral medications for MS have contributed to dramatic improvements in MS treatment. This study aims to evaluate the safety and efficacy ...
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Background: Although widely used, first-line injectable medicines for the treatment of multiple sclerosis (MS) remain an issue of efficacy and adherence. Recently, new oral medications for MS have contributed to dramatic improvements in MS treatment. This study aims to evaluate the safety and efficacy of oral disease-modifying drugs (DMDs) used in relapsing-remitting MS (RRMS). Methods: A systematic review was conducted on related databases including PubMed, Scopus, Cochrane, and Web of Science up to April 2020. The screening of the studies and their quality assessment was carried out independently by the two authors. Results: Three studies fulfilled the predefined criteria of inclusion. One of them compared teriflonomide with subcutaneous interferon beta-1a (IFN β-1a), another compared oral fingolimod with intramuscular (IM) IFN β-1b, and the third article compared oral fingolimod with IM IFN β-1a. No eligible study was found for dimethyl fumarate (DMF). The results indicated that while the efficacy of fingolimod was more than IFN β (IM β-1a and β-1b), teriflunomide 7 mg had less efficacy than subcutaneous IFN β-1a. Regarding safety, the results indicated that the proportion of diabetic patients with adverse events (AEs) in the fingolimod group was higher than in the IFN β-1b group and the overall occurrence of AEs was similar between teriflunomide and IFN β-1a groups. Conclusion: There is evidence for the effectiveness of fingolimod in reducing annualized relapse rates (ARRs) and improving magnetic resonance imaging (MRI) findings, but the evidence does not support the effectiveness of teriflunomide and further studies are required to determine its efficacy. Also, fingolimod is associated with more side effects than IFN β-1b, but there is no evidence to suggest any difference in side effects between teriflunomide and IFN β-1a.
Zahra Aajami; Abbas Kebriaeezadeh
Volume 18, Issue 1 , January 2019, , Pages 7-12
Abstract
Background: Alzheimer’s disease (AD) affects a large number of adults annually all around the world. The monetary cost of this disorder is huge. This study aims to estimate the cost of AD in Iran by considering stages of disease.
Methods: A cross-sectional study was designed from July to December ...
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Background: Alzheimer’s disease (AD) affects a large number of adults annually all around the world. The monetary cost of this disorder is huge. This study aims to estimate the cost of AD in Iran by considering stages of disease.
Methods: A cross-sectional study was designed from July to December 2017 on 300 AD cases who referred to the Iran Alzheimer’s Association, Tehran, Iran. To calculate costs at different stages of disease, patients were assigned into three groups, based on the Mini-Mental State Exam (MMSE) score. A list of medicines’ prices and health care service costs were prepared. Health care services’ cost was acquired from the book of “Relative value units of health care services in Iran” and the price of medicines was extracted from "Iran’s medicine triple prices list". Patients’ medical records and face to face interview with their caregivers were used for data collection. The perspective of present research was societal.
Results: Annually, per person cost of AD in mild, moderate, and severe stages of disease were 434 United States dollars (USD), 1313 USD, and 2480 USD, respectively. Direct non-medical costs (DNMC) had the greatest share of total costs (near half of the whole costs) including 263 USD, 641 USD, and 1257 USD for mild, moderate, and severe stages, respectively.
Conclusion: The cost of AD in Iran is lower than the average cost of dementia in upper middle-income countries. In all stages, the biggest part of the cost is associated with patient care and nursing services because patients suffering from AD usually require specialized cares.
Amir Hashemi-Meshkini; Hedieh Sadat Zekri; Hasan Karimi-Yazdi; Pardis Zaboli; MohammadAli Sahraian; Shekoufeh Nikfar
Volume 17, Issue 3 , July 2018, , Pages 123-128
Abstract
Background: Pegylated (PEG) interferon beta 1a has been approved by the United States Food and Drug Administration (USFDA) as an alternative to interferon beta 1a for multiple sclerosis (MS). Due to its higher price, this study aimed to evaluate the cost-effectiveness of PEG-interferon beta 1-a compared ...
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Background: Pegylated (PEG) interferon beta 1a has been approved by the United States Food and Drug Administration (USFDA) as an alternative to interferon beta 1a for multiple sclerosis (MS). Due to its higher price, this study aimed to evaluate the cost-effectiveness of PEG-interferon beta 1-a compared with interferon beta 1a from an Iranian payer perspective.
Methods: A Markov model was designed according to health states based on Expanded Disability Status Scale (EDSS) and one-month cycles over a 10-year time horizon. Direct medical and non-medical costs were included from a payer perspective.
Results: The incremental cost-effectiveness ratio (ICER) was estimated around 11111 US dollars (USD) per quality-adjusted life-year (QALY) gained for the PEG-interferon versus interferon regimen [with currency rate of 29,000 Iranian Rial (IRR) to 1 USD in 2016].
Conclusion: Considering the cost-effectiveness threshold in Iran [three times of gross domestic product (GDP) per capita or 15,945 USD], PEG-interferon beta 1-a could be considered as a cost effective treatment for Iranian patients with MS.
