Iranian Health Research Articles

To what extent has the Iranian Health Transformation Plan addressed inequality in healthcare financing in Iran?

BackgroundOne of the major goals of health systems is providing a financing strategy without inequality; this has a significant impact on people’s access to healthcare. The present study aimed to investigate the inequality in households’ financial contribution (HFC) to health expenditure both before and after the implementation of the Iranian Health Transformation Plan (HTP) in 2014.MethodsThis study is a secondary analysis of two waves of a national survey conducted in Iran. The data were collected from the Households Income and Expenditure Survey in 2013 and 2015. The research sample included 76,195 Iranian households. The inequality in households’ financial contributions to the health system was assessed using the Gini coefficient, and the concentration index (CI). In addition, by using econometric modeling, the relationship between the implementation of the HTP and inequality in HFC was studied. The households’ financial contribution included healthcare and health insurance prepayments.ResultsThe Gini coefficient values were 0.67 and 0.65 in 2013 and 2015, respectively, indicating a medium degree of inequality in HFC in both years. The CI values were 0.54 and 0.56 in 2013 and 2015, respectively, suggesting that inequalities in HFC were in favor of higher income quintiles in the years before and after the implementation of the HTP. Regression analysis showed that households with a female head, with an unemployed head, or with a head having income without a job were contributing more to financing health expenditure. The presence of a household member over the age of 65 was associated with a higher level of HFC. The implementation of the HTP had a negative relationship with the HFC.ConclusionThe HTP, aiming to address inequality in the financing system, did not achieve the intended goal as expected. The implementation of the HTP neglected certain factors at the household level, such as the presence of family members older than the age of 65, a female household head, and unemployment. This resulted in a failure to reduce the inequality of the HFC. We suggest that, in the future, policymakers take into account factors at the household level to reduce inequality in the HFC.

Identifying and Prioritizing Social Determinants of Population Health in Iran: A Mixed Method Research

Background and Purpose: In recent decades, research has shown that social determinants of health (SDH) affect population health more than medical care. Therefore, identifying the SDH has become a top priority. Materials and Methods: It is an explanatory-sequential mixed-method study. We used the meta-synthesis method in the first step to identify and prioritize social determinants of population health in Iran. Then, the identified factors were shown in a semantic map. Afterward, we used fuzzy Delphi to screen and determine each factor’s importance in Iran. Results: A total of 172 factors were identified and classified into 4 levels: individual, local, national, and global. After screening items, parental competence, hope, addiction, types of pollution, inflation, and unemployment rate (the crisp value of defuzzification 9-10) are generally the most important determinants of population health at the individual and national levels in Iran. Conclusion: The resulting semantic map of SDH demonstrates the substantial effect of non-health policies on the health of Iran’s population. This finding proposes health as a complex and comprehensive system needing an interdisciplinary approach to address its multiple determinants. Specifically, the comparative analysis of this research shows that among the determinants of health in Iran, parental competence, individual behaviors such as addiction, and spiritual and mental health, including depression, suicide, and stress, are the most important SDH in Iran.

Utilization and cost of outpatient services: A cross-sectional study on the Iran Health Insurance Organization insurees in Fars province.

Analyzing the utilization of health services is necessary for allocating the resources and planning the provision of health services. The present study aimed at investigating the utilization and cost of outpatient services and the factors affecting it among the insurees of the Iran Health Insurance Organization in Fars province in 2019. The study population consisted of all Iran Health Insurance Organization insurees in Fars province in 2019 (n = 2,618,973). The data on the utilization and cost of the services were extracted from the information systems of Fars Health Insurance Organization. The descriptive statistics of the utilization and cost of outpatient services were provided by gender, age, and type of insurance fund. The effects of different factors on the utilization and cost of various services were also investigated using univariate analysis as well as cross-sectional regression. The data analysis was done using EXCEL and STATA 15 software as well. The average utilization rates of laboratory, drug, and radiology services were 0.940, 0.945, and 0.108 prescriptions per year, respectively. In addition, the mean costs of laboratory, drug, and radiology services were $1.13, $7.44, and $2.26 per year, respectively. The univariate and multivariate analyses showed that gender, type of insurance fund, and age had significant effects on the utilization and costs of laboratory, drug, and radiology services (p < 0.05). The utilization and expenditure of outpatient services were higher among the elderly and women. To control the costs of insurance organizations, it is helpful to identify the effective factors. In addition, due to the increasing trend of aging in Iran, it seems necessary to periodically monitor the pattern of the elderly people's utilization of health services and to plan to increase sustainable resources for insurance financing in the coming years.

The Association Between Pre-Pregnancy Body Mass Index and Gestational Weight Gain on Pregnancy Outcomes: A Retrospective Cohort Study

Introduction: Elevated pre-gestational body mass index (obese/overweight) and improper gestational weight gain are important risk factors for predicting adverse pregnancy outcomes. Objective: We aimed to identify the association between pre-pregnancy body mass index (BMI) and gestational weight gain on birth outcomes. Materials and Methods: Data from this retrospective cohort study were extracted from 1457 (out of 1800) pair health records belonging to the pregnant mother and infants at Ahvaz Iran health care centers from 2010 to 2018. Ten public health care centers were randomly selected from the headquarters west and east of Ahvaz City. The samples were selected based on the inclusion criteria. They divided into different groups based on BMI (underweight, normal, overweight, and obese) and gestational weight gain (GWG) groups (inadequate and excessive versus adequate). Pregnancy outcome was analyzed according to the GWG during pregnancy for each BMI group through multivariable multinomial logistic regression. Relationships between maternal BMI, GWG, and offspring weight were examined. The analysis of covariance (ANCOVA) was used with adjusting the baseline values. The risks for adverse birth weight outcomes in women with different pre-pregnancy BMIs and GWGs were tested using the multivariable multinomial logistic regression analysis. Results: The Mean±SD of maternal age was 28.36±5.60 years. The Mean±SD birth weight was 3271.37±486.57 g. About 4.5%, 89.3%, and 6.2% of newborns were low birth weight, normal weight, and macrosomia, respectively. Also, 46.4% of women had weight gain above the guidelines. The increased risk for large for gestational age in overweight mothers (odds ratio [OR] =3.18, 95%CI; 0.45-7.29, P=0.007) and an increased risk for small for gestational age in those mothers with gestational weight gain below the guidelines (OR=2.9, 95%CI; 1.16- 7.45, P=0.02). An increased risk of large for gestational age, low birth weight, and macrosomia were observed in overweight mothers with gestational weight gain out of the guidelines. An increased association was found between the maternal pre-pregnancy BMI and fasting blood sugar in 24 to 28 weeks of gestation. Hence, hyperglycemia is related to the incidence of macrosomia (OR=3.58, 95%CI; 1.70-7.66, P=0.0001). Conclusion: Managing maternal weight with respect to reproductive health care is required for all women in childbearing age (before and during pregnancy) to reduce the adverse pregnancy outcome.

The influence of home and environmental characteristics on 5-18 years old children's health during the COVID-19 pandemic: A cross-sectional study in Iran.

The coronavirus disease (COVID-19) pandemic has dramatically changed the health and wellbeing of children. Therefore, this study aimed to investigate the relationship between the home environment and the environmental characteristics on 5-18 years old children health in Iran. An online survey was conducted among parents of children aged 5 to 18 living in large cities in Iran in 2021. The statistical population of this cross-sectional study was 500 people. In this survey, questionnaires on the quality of the home environment, exterior and interior landscapes of homes, and the Child Health Questionnaire (CHQ) were used to investigate the relationship between the home environment and environmental characteristics on 5-18 years old children health during the COVID-19 pandemic. The t-test and analysis of variance were used in SPSS 24, and the structural equation modeling (SEM) was utilized in AMOS 24 for analyzing the data. The average age of respondents was 37.13 ± 7.20, and that of children was 11.57 ± 3.47. 73.02% of the families were covered by insurance, and 74.08% of them lived in the metropolis. In addition, 65.04% of the families complied with the restrictions of the quarantine period. A share of 31% of the families live in villas, and 55% paid more attention to cleaning their homes during the COVID-19 pandemic than before. A positive and significant statistical relationship (β = 0.414, p < 0.001) was observed between the residence environment and child health. Thus, explained 17.5% of variations in child health. The results showed that the children who lived in homes with an exterior landscape in nature had better health. In addition, the 5-18 years old children whose home landscape was a garden, compared to the other two groups (yard, balcony), had better health. Gardens are a potential source of health and not necessarily replaced by other natural environments, thus providing them along with green space is one of the crucial issues that should be considered.

A model of financial support for the poor to access health services in Iran: Delphi technique

PurposeReducing inequity in health between the poor and the rich is one of the challenges of the Iranian health sector. Access to health services in Iran is lower in the lowest-income quarter, and the rich use health services more. The purpose of this study is to provide a comprehensive framework for enabling financial access by the poor to health services in Iran.Design/methodology/approachPolicy options were validated and approved by experts and specialists in two stages using the Delphi technique. The sample was consisted of 22 well-known experts on the subject who were selected based on purposive sampling. To evaluate the reliability of the questionnaire, a pilot study was conducted with five participants. Dimensional validity of the policy model, which was agreed upon by more than 75% of the participants was acceptable.FindingsThe main aspects of the model were divided into five categories: identifying the poor, policymaking to prevent the aggravation of health poverty, providing targeted funding, highlighting the importance of coherent regulation and ensuring financial accessibility to health services for the poor. This model could align the activities of all stakeholders in the form of a network and considers its prerequisites.Originality/valuePrevention of dire financial consequences in the case of referral to follow up the treatment alongside exemption and financial protection policies through the networking activities of organizations involved in this field is a crucial step in securing financial support for the poor. Although the researchers included a wide range of policymakers in the Delphi study to gather all perspectives about options for financially support the poor, there may be some potential neglected policy advices.

How Do Iranian Researchers Measure Spirituality in Health Studies? A Scoping Review.

Despite the existing literature on the effect of spirituality on health, lack of consensus on definition and evaluation methods are major barriers to applying the results of these studies. In this scoping review, we intend to identify the instruments used for evaluating spirituality in health in Iran and evaluate their domains. We searched PubMed, Scopus and Web of Science, Islamic World Science Citation Center, Scientific Information Database, and Magiran between 1994 and 2020. We then identified the questionnaires and searched for the original article reporting the development or translation, as well as the psychometric evaluation process. We extracted data on their type (developed/translated), and other psychometric properties. Finally, we categorized the questionnaires accordingly. After selecting the studies and evaluating the questionnaires, we identified 33 questionnaires evaluating religiosity (10 questionnaires), spiritual health (8 questionnaires), spirituality (5 questionnaires), religious attitude (4 questionnaires), spiritual need (3 questionnaires) and spiritual coping (3 questionnaires). Other existing questionnaires had issues in the development or translation process or lacked reported psychometric evaluations. Many questionnaires have been used in spiritual health studies in the Iranian population. These questionnaires cover different subscales according to their theoretical base and the developers' perspectives. Researchers should be informed about these aspects of the questionnaires and select the instruments meticulously based on the aim of their study and the characteristics of the questionnaires.

What Do Future Trends in Medical Education Mean to the Scientific Development of Iran's Health System?

Medical education system in Iran has an essential role in responding to scientific development targets from both education and research perspectives. Investigating future trends and analyzing how they interact with the medical education system helps increase awareness and give insight into the preferred future. The present qualitative study consists of Systematic reviews and interviews that have been analyzed using content analysis. Afterward, the themes and codes were visualized in the form of maps and presented in a focus group discussion of experts to define how medical education trends will impact scientific development. The future trends of Iran's medical education system were classified into six groups: workplace changes, demographic changes, changes in concepts, the emergence of new players, structural changes in universities, and technology development. The next point is how they will influence science development. Their impact on science development is classified into five main groups or main streams of change of new financial models, open science, redesigning the research management, the role of universities, and capacity building. Our findings showed that redesigning the structure of medical education is the most important priority to make the system as agile as needed to capture the signs and act. New meanings and concepts should also be considered in restructuring, like power balance, competency-based and personalized education, cost-effectiveness, and openness.

Barriers and Facilitators to Participatory Governance in Iran Health Policymaking: A Qualitative Study.

Community participation has been accepted as a promising approach to promoting health and health equality. Based on Iran's constitution and the general health policies, community participation in health is addressed as a right, and during recent decades, some measures have been put in place. However, it is critical to improve public participation in Iran's health system and institutionalize community participation in health policymaking. This study aimed to identify barriers and facilities affecting public participation in Iran's health policymaking. Semi-structured qualitative interviews with health policymakers, health managers and planners, and other stakeholders were conducted to collect data. The conventional content analysis approach was used to analyze the data. Two themes-including community level and government level-and 10 categories were identified through the qualitative analysis. Cultural and motivational factors, lack of awareness of the right to participate, and lack of sufficient knowledge and skills are among the identified barriers in the process of establishing effective interaction. From the health governance perspective, a lack of political will is identified as one of the obstacles. A culture of community involvement and political will are pivotal in the sustainability of community participation in health policymaking. The provision of a suitable context for participatory processes and capacity building on the community and government levels can be useful in institutionalizing community participation in the health system.

Nurses’ perceptions of critically ill patients’ eye care: a qualitative study in Iran

BackgroundDespite the high prevalence of ocular complications in patients admitted to the intensive care unit (ICU), eye care, as an important component of the care plan, has not received much attention from nurses. To improve the quality of eye care, the challenges and concerns of ICU nurses should be studied deeply. Thus, the present study aimed at exploring the challenges faced by ICU nurses in taking care of patients admitted to the ICU.MethodsThe present conventional qualitative content analysis study was carried out on 11 nurses and 3 head nurses selected purposefully by observing the maximum variation. The data were collected through face-to-face, in-depth, and semi-structured interviews. All data were recorded, transcribed, and analyzed using the conventional content analysis method proposed by Graneheim and Lundman (Nurse Educ Today 24:105–12, 2004). The Max Q Data software 2020 was run to record the interviews and extract codes from the transcriptions.ResultsThe participants’ mean age was 37.14 ± 6.41 years and their average work experience in ICU was 10.29 ± 7.63 years. The core category that emerged from data analysis was “the lack of an evidence-based approach”, which was subdivided into five categories: “education, the missing link”, “nurses’ inadequate professional competence”, “unsafe nursing care”, “organizational requirements”, and “difficulty in eye care evaluation”.ConclusionEvidence-based practice plays a minor role in the field of eye care in Iran, despite its critical importance. Thus, the Ministry of Health and Medical Education of Iran is recommended to adapt the clinical guidelines so that more attention is paid to this field.

Resiliency of the Iranian healthcare facilities against the Covid-19 pandemic: challenges and solutions

BackgroundHealth care facilities are responsible for preventing and controlling diseases and must be resilient enough to deal with crises. The Iranian health care facilities have faced challenges in managing COVID-19 pandemic. The purpose of this study was to identify the challenges faced by the Iranian health care facilities during the Covid-19 epidemic and to provide solutions.MethodsThis qualitative study was conducted with a phenomenological approach and using semi-structured interviews with 59 healthcare policy makers, managers, and employees, and medical university faculty members. The participants were selected through purposive and snowball sampling. Thematic analysis was used to analyze the data.ResultsOverall, 43 challenges to the resilience of health care facilities during the Covid-19 pandemic were identified and grouped into 8 themes (i.e., leadership and management, planning, organizational culture, organizational learning, employee management, customer management, resource management, and process management. The most important resilience challenges were: fragmented management system; poor leadership; incompatible health network structure; lack of a national holistic plan; poor case detection; insufficient resources; inefficient information system; negative attitude of managers and employee; organizational inertia; failure to build on lessons learned from crises; low workforce preparedness; lack of community-based management; and improper monitoring and evaluation. Managers should use community-based, evidence-based, and integrated management to build health system resilience against COVID-19, have sufficient knowledge and experience to organize operations, use appropriate and effective coordination models, develop a creative and participatory culture, reengineer processes, and provide necessary resources.ConclusionThe Iranian health care facilities face challenges that prevent them from becoming resilient, responsive, and efficient in managing COVID-19. Policy makers and managers should increase the resilience of health care facilities to shocks and crises by using the suggested measures.

Developing a conceptual model of post-disaster damage and loss assessment program in the Iranian health sector: a qualitative study protocol

IntroductionAnnual natural and man-made disasters in Iran eventually lead to casualties and considerable financial loss. The success of a reconstruction programme depends on accurate postdisaster damage and loss assessment. Based...

Effect of the chronic medication use on outcome measures of hospitalized COVID-19 patients: Evidence from big data.

Concerns about the role of chronically used medications in the clinical outcomes of the coronavirus disease 2019 (COVID-19) have remarkable potential for the breakdown of non-communicable diseases (NCDs) management by imposing ambivalence toward medication continuation. This study aimed to investigate the association of single or combinations of chronically used medications in NCDs with clinical outcomes of COVID-19. This retrospective study was conducted on the intersection of two databases, the Iranian COVID-19 registry and Iran Health Insurance Organization. The primary outcome was death due to COVID-19 hospitalization, and secondary outcomes included length of hospital stay, Intensive Care Unit (ICU) admission, and ventilation therapy. The Anatomical Therapeutic Chemical (ATC) classification system was used for medication grouping. The frequent pattern growth algorithm was utilized to investigate the effect of medication combinations on COVID-19 outcomes. Aspirin with chronic use in 10.8% of hospitalized COVID-19 patients was the most frequently used medication, followed by Atorvastatin (9.2%) and Losartan (8.0%). Adrenergics in combination with corticosteroids inhalants (ACIs) with an odds ratio (OR) of 0.79 (95% confidence interval: 0.68-0.92) were the most associated medications with less chance of ventilation therapy. Oxicams had the least OR of 0.80 (0.73-0.87) for COVID-19 death, followed by ACIs [0.85 (0.77-0.95)] and Biguanides [0.86 (0.82-0.91)]. The chronic use of most frequently used medications for NCDs management was not associated with poor COVID-19 outcomes. Thus, when indicated, physicians need to discourage patients with NCDs from discontinuing their medications for fear of possible adverse effects on COVID-19 prognosis.

Socioeconomic inequality in informal payments for health services among Iranian households: a national pooled study

BackgroundThere is limited evidence on the prevalence and socioeconomic inequality in informal payments (IP) of households in the Iranian health system. This study was conducted to investigate the prevalence of IP and related socioeconomic inequalities among Iranian households in all provinces.MethodData on Household Income and Expenditure Surveys (HIES) for 91,360 households were used to examine the prevalence and inequality in informal health sector payments in the years 2016 to 2018. The Normalized Concentration Index (NC) was used to examine inequality in these payments and the decomposition analysis by the Wagstaff approach was used to determine the share of variables affecting the measured inequality.ResultsOf the total households, 7,339 (7.9%) reported IP for using health services. Urban households had higher IP (10%) compared to rural ones (5.42%). Also, the proportion of households with IP in 2016 (11.69%) was higher than in 2017 (9.9%), and 2018 (4.60%). NC for the study population was 0.129, which shows that the prevalence of IP is significantly higher in well-off households. Also, NC was 0.213 (p < 0.0001) and -0.019 for urban and rural areas, respectively (p > 0.05). Decomposition analysis indicated that income, sex of head of household, and the province of residence have the highest positive contribution to measured inequality (with contributions of 156.2, 45.8, and 25.6%, respectively).ConclusionThere are a significant prevalence and inequality in IP in Iran's health system and important variables have shaped it. On the whole, inequality was pro-rich. This may lead to increasing inequality in access to quality services in the country. Our findings showed that previous health policies such as regulatory tools, and the health transformation plan (HTP) have not been able to control IP in the health sector in the desired way. It seems that consumer-side policies focusing on affluent households, and high-risk provinces can play an important role in controlling this phenomenon.

Factors affecting burnout in Iranian health care workers during COVID-19: a systematic review

Factors affecting burnout in Iranian health care workers during COVID-19: a systematic review

The Integrated Electronic Health System in Iranian health centers: benefits and challenges

BackgroundElectronic Health Records (EHRs) were introduced to all Iranian medical universities in 2015 with the launch of Integrated Electronic Health System (which is known as SIB: a Persian backronym in Persian meaning apple), and a number of studies were conducted on SIB. However, most of these studies did not consider the benefits and challenges of adopting SIB in Iran. Therefore, the present study aimed to identify the benefits and challenges of SIB in health centers of Khuzestan Province, Iran.MethodsThis was a qualitative study using qualitative conventional content analysis conducted on 6 experts and 24 users of SIB in six health centers of three cities in Khuzestan province, Iran. The participants were selected using a purposeful sampling method. Maximum variation was considered in selecting the group of users, and snowball sampling was used in the group of experts. Data collection tool was semi-structured interview. Data analysis was performed using thematic analysis.ResultsOverall, 42 components (24 for benefits and 18 for challenges) were extracted from the interviews. Common sub-themes and themes were identified for challenges and benefits. The components formed 12 sub-themes, and they were placed in 3 main themes, namely structure, process and outcome. 1) Structure included four sub-themes of Financial resources, Human resources, Facilities, and Access to the Internet; 2) Process involved three sub-themes of Training, Providing services, and Time and workload; and 3) Outcome incorporated five sub-themes of Quality of health services, Access, Safety and personal distance, Screening and evaluation, and Research.ConclusionsIn the present study, the benefits and challenges of adopting SIB were examined in three themes: structure, process, and outcome. Most of the identified benefits were related to the theme of outcome, and most of the identified challenges were related to the theme of structure. Based on the identified factors, by strengthening the benefits of SIB and also trying to eliminate or reduce its challenges, it is possible to institutionalize and use it more effectively in order to solve health problems.

Actors in conflict of interest in Iran's health system: Ranking and policy recommendations for conflict of interest management

AbstractWe conducted this study to rank conflict of interest (COI) actors in Iran's health system. Based on a review of relevant literature, we extracted a list of 27 actors within seven categories who play roles in the COI in the health system. We considered three criteria for ranking the actors: the actor's interest, power, and authority concerning COI. Each actor scored one to five on the Likert scale in every criteria. Using descriptive statistics, each actor's mean and standard deviation of its scores were calculated in these three indicators. The actors were ranked using the fuzzy TOPSIS method. The results showed the leading players in abusing the COI in the health system of Iran are the “Food and Drug Organization” and the “Parliament.” The role and capacity of civil society and nongovernmental organizations as essential arms of oversight and transparency should not be overlooked. The government needs to enhance its efforts, we envisage, to utilize the capability of these actors by opening a dialog with them and providing the necessary training for COI.

Occupational Noise-Induced Hearing Loss in Iran: A Systematic Review and Meta-Analysis.

A large portion of Iranian Working Population (IWP) is becoming at risk of Occupational Noise-Induced Hearing Loss (ONIHL). Several primary studies have evaluated the prevalence of ONIHL in Iran with a variety of prevalence rates. We aimed to estimate the prevalence of ONIHL in the IWP using data from relevant studies. The present study is a meta-analysis and systematic review of previously published studies on ONIHL in Iran. Accordingly, the relevant articles published until Sep 1, 2021 were searched through Pub-Med, Scopus, and Google Scholar, together with Iranian scientific electronic databases. Heterogeneity between among the studies and data analysis was assessed using the I2 test and Random-Effect Model (REM) respectively. Having performed a quality assessment, the meta-analysis was performed on the data from twenty-six studies involving a total of 85685 participants. The prevalence of ONIHL was observed to range from 12.9% to 60.5% in the reviewed studies. Moreover, after combining the results from the primary research by the Random Effects Model (REM) approach, the prevalence of ONIHL among IWP was estimated to be 34.69% (95% CI: 29.10, 40.28). ONIHL is a significant concern with regard to public and occupational health in Iran. The results also highlighted the urgent need for taking appropriate preventive and control measures in the work-places; particularly by encouraging the employers and health-related policymakers to focus on preventive noise control techniques along with administrative and legislative approaches to mitigate the risk of developing ONIHL.

Health Conditions in Tehran's Girl Schools from 1927 to 1934: A Brief Survey.

A new model of relations emerged in schools after the establishment of new educational centers in Iran in the mid-Qajar era. The cultural authorities of the time were particularly interested in school health, which was adopted as a principle from the European, particularly French, school systems. During the period 1925 to 1941, with special attention to the new Western models of education, school health changed more and more. This study provides a descriptive-analytical report on state health policies in girl schools in Tehran, Iran, from 1927 to 1934, based on health records available at the National Archives of Iran. The findings reveal that since the mid-first Pahlavi era, officials from the Ministry of Science became increasingly involved in the issue of health, which resulted in institutionalization of health and medical examination of students, establishment of the School Health Office, publication of theoretical health discussions in magazines, and teaching of health principles to students, thereby improving the level of health in Tehran schools during the study period. The study aims to provide Iranian physicians and health policymakers with a review of this historical experience.

Cost-utility analysis and net monetary benefit of Platelet Rich Plasma (PRP), intra-articular injections in compared to Plasma Rich in Growth Factors (PRGF), Hyaluronic Acid (HA) and ozone in knee osteoarthritis in Iran

PurposeTo evaluate the cost-effectiveness of Platelet Rich Plasma (PRP), Plasma Rich in Growth Factors (PRGF), Hyaluronic Acid (HA) and ozone as effective treatment approaches in knee osteoarthritis management from Iran Health care perspective.MethodsA decision tree model was conducted to assess the cost-effectiveness of four common intra-articular treatment approaches in patients with mild and moderate knee osteoarthritis. The data on clinical effectiveness was obtained from a randomized controlled trial (RCT) conducted in Iran and used to estimate utility values. The direct medical costs were estimated according to tariffs for public medical centers and hospitals, approved by the Iran Ministry of Health and Medical Education in 2021. The incremental cost-effectiveness ratio (ICER) and the net monetary benefit (NMB) were used to evaluate the cost-utility analysis. Deterministic and probabilistic sensitivity analyses are performed to investigate the robustness of the results and account for the different sources of uncertainty.ResultsIn this study, HA intra-articular injection-related costs ($581.67/patient) were defined as the highest cost, followed by PRGF ($328.10/patient), PRP (318.58/patient), and Ozone (103.20/patient). According to the utility value, PRP and PRGF (0.68) have the same and the most utility among Intra-articular injections in knee osteoarthritis management. However, the PRP injection method was identified as the most cost-effective intervention due to its high NMB and ICER estimates. Based on the Monte Carlo Simulation, PR intervention, compared to other ones, was introduced as the dominant strategy regarding knee OA management, with a WTP of $10,000 for 100% of cases.ConclusionThe study result demonstrated that intra-articular injection of PRP, compare to other injections, is a cost-effective treatment option for patients with mild and moderate knee osteoarthritis. In addition, intra-articular injection of PRP was identified as the best injection, with the highest level of net monetary benefit, for knee OA management.