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Article ; Online: Prevalence of HIV in slums area: a systematic review and meta-analysis.

Behzadifar, Meysam / Ehsanzadeh, Seyed Jafar / Darvishi Teli, Banafshe / Azari, Samad / Bakhtiari, Ahad / Behzadifar, Masoud

BMC infectious diseases

2024 Volume 24, Issue 1, Page(s) 52

Abstract: Background: Human Immunodeficiency Virus (HIV) remains a significant global health burden, particularly affecting vulnerable populations residing in slum areas which is characterized by overcrowding, poverty, and limited access to healthcare services, ... ...

Abstract	Background: Human Immunodeficiency Virus (HIV) remains a significant global health burden, particularly affecting vulnerable populations residing in slum areas which is characterized by overcrowding, poverty, and limited access to healthcare services, create an environment conducive to the transmission and spread of HIV. Despite the recognition of this issue, there is a lack of comprehensive understanding regarding the prevalence of HIV in slums. The aim of this study was to systematically synthesize the existing global evidence on HIV prevalence in slum populations. Methods: A rigorous systematic literature review was conducted by searching multiple electronic databases, including Medline via PubMed, Scopus, Embase, Web of Sciences, and Directory of Open Access Journals (DOAJ), covering the period from January 1, 1990, to March 31, 2023. The quality and risk of bias for each included study were assessed using the Newcastle-Ottawa Scale. The pooled prevalence with its corresponding 95% confidence interval (CI) was calculated using a random-effects model with the Freeman-Tukey double arcsine transformation. The degree of heterogeneity among the studies was evaluated using the I Results: A systematic examination of the relevant literature resulted in the inclusion of a total of 22 studies for the purpose of this meta-analysis. These studies collectively assessed a sizable cohort consisting of 52,802 participants. Utilizing a random-effects model, an estimation of the overall prevalence of HIV in the slum area was determined to be 10% (95% CI: 7-13%). Further delineation through subgroup analysis based on the gender revealed a higher prevalence of HIV among women, standing at 13% (95% CI: 8-19%, 18 studies: I Conclusion: The current study elucidates the troublingly high prevalence of HIV infection within slums area. Also, this finding underscores the urgent necessity for targeted and tailored interventions specifically aimed at curtailing the spread of HIV within slums. Policymakers must take cognizance of these results and devote their efforts towards the implementation of effective strategies to mitigate gender disparities, address poverty alleviation, and empower the inhabitants of these marginalized areas.
MeSH term(s)	Female ; Humans ; Male ; HIV/isolation & purification ; HIV Infections/epidemiology ; Poverty ; Poverty Areas ; Prevalence
Language	English
Publishing date	2024-01-05
Publishing country	England
Document type	Meta-Analysis ; Systematic Review ; Journal Article
ZDB-ID	2041550-3
ISSN	1471-2334 ; 1471-2334
ISSN (online)	1471-2334
ISSN	1471-2334
DOI	10.1186/s12879-023-08877-7
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Article ; Online: Cost-effectiveness of brentuximab vedotin in Hodgkin lymphoma: a systematic review.

Arabloo, Jalal / Azari, Samad / Gorji, Hasan Abolghasem / Rezapour, Aziz / Alipour, Vahid / Ehsanzadeh, Seyed Jafar

European journal of clinical pharmacology

2023 Volume 79, Issue 11, Page(s) 1443–1452

Abstract: Purpose: This study aimed to systematically review and critically appraise cost-effectiveness studies on Brentuximab vedotin (BV) in patients with Hodgkin lymphoma (HL).: Methods: The PubMed, Scopus, Web of Science core collection, and Embase ... ...

Abstract	Purpose: This study aimed to systematically review and critically appraise cost-effectiveness studies on Brentuximab vedotin (BV) in patients with Hodgkin lymphoma (HL). Methods: The PubMed, Scopus, Web of Science core collection, and Embase databases were searched until July 3, 2022. We included published full economic evaluation studies on BV for treating patients with HL. The methodological quality of the studies was assessed using the Quality of Health Economic Studies (QHES) checklist. Meanwhile, we used qualitative synthesis to analyze the findings. We converted the incremental cost-effectiveness ratios (ICERs) to the value of the US dollar in 2022. Results: Eight economic evaluations met the study's inclusion criteria. The results of three studies that compared BV plus doxorubicin, vinblastine, and dacarbazine (BV + AVD) front-line therapy with doxorubicin, bleomycin, vincristine, and dacarbazine (ABVD) showed that BV is unlikely to be cost-effective as a front-line treatment in patients advanced stage (III or IV) HL. Four studies investigated the cost-effectiveness of BV in patients with relapsed or refractory (R/R) HL after autologous stem cell transplantation (ASCT). BV was not cost-effective in the reviewed studies at accepted thresholds. In addition, the adjusted ICERs ranged from $65,382 to $374,896 per quality-adjusted life-year (QALY). The key drivers of cost-effectiveness were medication costs, hazard ratio for BV, and utilities. Conclusion: Available economic evaluations show that using BV as front-line treatment or consolidation therapy is not cost-effective based on specific ICER thresholds for patients with HL or R/R HL. To decide on this orphan drug, we should consider other factors such as existence of alternative treatment options, clinical benefits, and disease burden.
MeSH term(s)	Humans ; Hodgkin Disease/drug therapy ; Hodgkin Disease/etiology ; Brentuximab Vedotin/therapeutic use ; Cost-Benefit Analysis ; Hematopoietic Stem Cell Transplantation ; Doxorubicin ; Antineoplastic Combined Chemotherapy Protocols/adverse effects ; Bleomycin/therapeutic use ; Vinblastine/therapeutic use ; Vinblastine/adverse effects ; Dacarbazine/therapeutic use ; Dacarbazine/adverse effects ; Transplantation, Autologous
Chemical Substances	Brentuximab Vedotin (7XL5ISS668) ; Doxorubicin (80168379AG) ; Bleomycin (11056-06-7) ; Vinblastine (5V9KLZ54CY) ; Dacarbazine (7GR28W0FJI)
Language	English
Publishing date	2023-09-01
Publishing country	Germany
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	121960-1
ISSN	1432-1041 ; 0031-6970
ISSN (online)	1432-1041
ISSN	0031-6970
DOI	10.1007/s00228-023-03557-6
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Article ; Online: Exploring the landscape of health technology assessment in Iran: perspectives from stakeholders on needs, demand and supply.

Aryankhesal, Aidin / Behzadifar, Meysam / Bakhtiari, Ahad / Shahabi, Saeed / Azari, Samad / Darvishi Teli, Banafshe / Rezapour, Aziz / Ehsanzadeh, Seyed Jafar / Behzadifar, Masoud

Health research policy and systems

2024 Volume 22, Issue 1, Page(s) 11

Abstract: Background: The evaluation of health technologies plays a crucial role in the allocation of resources and the promotion of equitable healthcare access, known as health technology assessment (HTA). This study focuses on Iran's efforts to integrate HTA ... ...

Abstract	Background: The evaluation of health technologies plays a crucial role in the allocation of resources and the promotion of equitable healthcare access, known as health technology assessment (HTA). This study focuses on Iran's efforts to integrate HTA and aims to gain insights into stakeholder perspectives regarding capacity needs, demand and implementation. Methods: In this study, we employed the HTA introduction status analysis questionnaire developed by the International Decision Support Initiative (iDSI), which has been utilized in various countries. The questionnaire consisted of 12 questions divided into three sections: HTA need, demand and supply. To identify key informants, we conducted a literature review and consulted with the Ministry of Health and Medical Education (MOHME), as well we experts in policy-making, health service provision and HTA. We selected stakeholders who held decision-making positions in the healthcare domain. A modified Persian version of the questionnaire was administered online from September 2022 to January 2023 and was pretested for clarity. The analysis of the collected data involved quantitative methods for descriptive analysis and qualitative methods for thematic analysis. Results: In this study, a total of 103 questionnaires were distributed, resulting in a favourable response rate of 61% from 63 participants, of whom 68% identified as male. The participants, when assessing the needs of HTA, rated allocative efficiency as the highest priority, with a mean rating of 8.53, thereby highlighting its crucial role in optimizing resource allocation. Furthermore, healthcare quality, with a mean rating of 8.17, and transparent decision-making, with a mean rating of 7.92, were highly valued for their impact on treatment outcomes and accountability. The importance of budget control (mean rating 7.58) and equity (mean rating 7.25) were also acknowledged, as they contribute to maintaining sustainability and promoting social justice. In terms of HTA demand, safety concerns were identified as the top priority, closely followed by effectiveness and cost-effectiveness, with an expanded perspective on the economy. However, limited access to local data was reported, which arose from various factors including data collection practices, system fragmentation and privacy concerns. The priorities of HTA users encompassed coverage, payment reform, benefits design, guidelines, service delivery and technology registration. Evidence generation involved the participation of medical universities, research centres and government bodies, albeit with ongoing challenges in research quality, data access and funding. The study highlights government support and medical education as notable strengths in this context. Conclusions: This study provides a comprehensive evaluation of Iran's HTA landscape, considering its capacity, demand and implementation aspects. It underlines the vital role of HTA in optimizing resources, improving healthcare quality and promoting equity. The study also sheds light on the strengths of evidence generation in the country, while simultaneously identifying challenges related to data access and system fragmentation. In terms of policy priorities, evidence-based decision-making emerges as crucial for enhancing healthcare access and integrating technology. The study stresses the need for evidence-based practices, a robust HTA infrastructure and collaboration among stakeholders to achieve better healthcare outcomes in Iran.
MeSH term(s)	Humans ; Male ; Delivery of Health Care ; Iran ; Policy Making ; Resource Allocation ; Technology Assessment, Biomedical ; Female
Language	English
Publishing date	2024-01-15
Publishing country	England
Document type	Review ; Journal Article
ZDB-ID	2101196-5
ISSN	1478-4505 ; 1478-4505
ISSN (online)	1478-4505
ISSN	1478-4505
DOI	10.1186/s12961-023-01097-0
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Article ; Online: Overuse of computed tomography for mild head injury: A systematic review and meta-analysis.

Saran, Maryam / Arab-Zozani, Morteza / Behzadifar, Meysam / Gholami, Mehrdad / Azari, Samad / Bragazzi, Nicola Luigi / Behzadifar, Masoud

PloS one

2024 Volume 19, Issue 1, Page(s) e0293558

Abstract: Background: Computed tomography (CT) scan is a common imaging technique used to evaluate the severity of a head injury. The overuse of diagnostic interventions in the health system is a growing concern worldwide. Objectives: The aim of this systematic ... ...

Abstract	Background: Computed tomography (CT) scan is a common imaging technique used to evaluate the severity of a head injury. The overuse of diagnostic interventions in the health system is a growing concern worldwide. Objectives: The aim of this systematic review is to investigate the rate of CT scan overuse in cases of mild head injury. Methods: Eligibility criteria: We encompassed observational studies-either designed as cohort, case-control, or cross-sectional investigations-that reported on CT scan overuse rates for mild head injuries. Studies had to be published in peer-reviewed, English-language sources and provide full content access Information sources: Web of Sciences, Scopus, Medline via PubMed, the Cochrane Library and Embase were searched from inception until April 1, 2023. Studies were included if reporting the overuse of CT scans for mild head injuries using validated criteria. Risk of bias: We used the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool to evaluate the risk bias assessment of included studies. Two independent reviewers evaluated the eligibility of studies, extracted data, and assessed study quality by using the Newcastle-Ottawa Scale. Synthesis of results: Overuse estimates were calculated using a random-effects model. Subgroup analyses were performed to investigate any sources of heterogeneity. Point rate of overuse of CT scans for mild head injuries was the main outcome measured as percentage point estimates with corresponding 95% CIs. Results: Included studies: Of the 913 potentially relevant studies identified, eight studies were selected for the final analysis. Synthesis of results: The pooled rate of CT scan overuse in patients with mild head injury was found to be 27% [95% CI: 16-43; I2 = 99%]. The rate of CT scan overuse in mild head injury cases varied depending on the criteria used. The rate of CT scan overuse was 37% [95% CI: 32-42; I2 = 0%] with the Glasgow Coma Scale (GCS), 30% [95% CI: 16-49; I2 = 99%] with the Canadian computed tomography head rule, and 10% [95% CI: 8-14; I2 = 0%] with the Pediatric Emergency Care Applied Research Network criterion (PERCAN). Based on subgroup analyses, the rate of CT scan overuse in mild head injury cases was observed to be 30% with the Canadian computed tomography head rule criterion, 43% with the National Institute for Health and Clinical Excellence criterion, and 18% with the New Orleans criterion. Conclusion: Limitations of evidence: The restricted number of included studies may impact generalizability. High heterogeneity was observed, leading to subgroup analyses based on age, assessment criteria, and study region. Absent data on overuse causes hinders drawing conclusions on contributing factors. Furthermore, this study solely addressed overuse rates, not associated harm or benefits. Interpretation: The overuse of CT scans in mild head injury patients is concerning, as it can result in unnecessary radiation exposure and higher healthcare costs. Clinicians and policymakers should prioritize the implementation of guidelines to reduce unnecessary radiation exposure, healthcare costs, and potential harm to patients. Trial registration: The study protocol of this review was registered in PROSPERO under the identification code CRD42023416080. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023416080.
MeSH term(s)	Humans ; Child ; Cross-Sectional Studies ; Canada ; Tomography, X-Ray Computed ; Glasgow Coma Scale ; Craniocerebral Trauma/diagnostic imaging
Language	English
Publishing date	2024-01-11
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0293558
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Article: The burden of nonrheumatic valvular heart diseases in Iran between 1990 and 2017: Results from the global burden of disease study 2017.

Arabloo, Jalal / Omidi, Negar / Rezapour, Aziz / Sarabi Asiabar, Ali / Mojtaba Ghorashi, Seyyed / Azari, Samad

International journal of cardiology. Heart & vasculature

2022 Volume 39, Page(s) 100956

Abstract: Background: Nonrheumatic valvular heart diseases (NRVDs) are some of the common and treatable cardiovascular diseases. The objective of this study was to describe the burden of NRVDs in Iran from 1990 to 2017 and to compare the findings with those from ... ...

Abstract	Background: Nonrheumatic valvular heart diseases (NRVDs) are some of the common and treatable cardiovascular diseases. The objective of this study was to describe the burden of NRVDs in Iran from 1990 to 2017 and to compare the findings with those from the world and in particular, the North Africa and Middle East (NAME) region. Methods: Using publicly available estimates from the Global Burden of Disease 2017 Study (the GBD 2017 Study) for Iran and the NAME region, we reported the years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs), and the prevalence for NRVDs by age group and sex between 1990 and 2017. Results: There were an estimated 174,071 cases and 957 deaths from NRVDs in Iran in 2017. In addition, 1844 YLDs, 21,661 YLLs, and 23,506 DALYs were caused by NRVDs in Iran in 2017. Between 1990 and 2017, the age-standardized prevalence rate increased in Ian by 15%, the death rate by 15.3%, and DALYs by 2%. Nevertheless, in the world and the NAME region, the age-standardized rates for DALYs and deaths decreased and the age-standardized prevalence rate increased till 2017. Conclusions: The burden of NRVDs is on the rise in Iran. A reduction in the burden of NRVDs in Iran requires the development of appropriate plans to meet the health needs of patients, the decrease of the modifiable risk factors, the allocation of adequate resources for the early diagnosis and management of the diseases, and an improvement in access to treatment technologies.
Language	English
Publishing date	2022-01-17
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	2818464-6
ISSN	2352-9067
ISSN	2352-9067
DOI	10.1016/j.ijcha.2022.100956
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Article ; Online: A SWOT analysis of the development of health technology assessment in Iran.

Behzadifar, Masoud / Ghanbari, Mahboubeh Khaton / Azari, Samad / Bakhtiari, Ahad / Rahimi, Sara / Ehsanzadeh, Seyed Jafar / Sharafkhani, Naser / Moridi, Salman / Bragazzi, Nicola Luigi

PloS one

2023 Volume 18, Issue 3, Page(s) e0283663

Abstract: Background: Health systems need to prioritize their services, ensuring efficiency and equitable health provision allocation and access. Alongside, health technology assessment (HTA) seeks to systematically evaluate various aspects of health technologies ...

Abstract	Background: Health systems need to prioritize their services, ensuring efficiency and equitable health provision allocation and access. Alongside, health technology assessment (HTA) seeks to systematically evaluate various aspects of health technologies to be used by policy- and decision-makers. In the present study, we aim to identify strengths, weaknesses, opportunities, and threats in developing an HTA in Iran. Method: This qualitative study was conducted using 45 semi-structured interviews from September 2020 to March 2021. Participants were selected from key individuals involved in health and other health-related sectors. Based on the objectives of the study, we used purposive sampling (snowball sampling) to select individuals. The range of length of the interviews was between 45 to 75 minutes. Four authors of the present study carefully reviewed the transcripts of interviews. Meanwhile, the data were coded on the four domains of strengths, weaknesses, opportunities, and threats (SWOT). Transcribed interviews were then entered into the software and analyzed. Data management was performed using MAXQDA software, and also analyzed using directed content analysis. Results: Participants identified eleven strengths for HTA in Iran, namely the establishment of an administrative unit for HTA within the Ministry of Health and Medical Education (MOHME); university-level courses and degrees for HTA; adapted approach of HTA models to the Iranian context; HTA is mentioned as a priority on the agenda in upstream documents and government strategic plans. On the other hand, sixteen weaknesses in developing HTA in Iran were identified: unavailability of a well-defined organizational position for using HTA graduates; HTA advantages and its basic concept are unfamiliar to many managers and decision-makers; weak inter-sectoral collaboration in HTA-related research and key stakeholders; and, failure to use HTA in primary health care. Also, participants identified opportunities for HTA development in Iran: support from the political side for reducing national health expenditures; commitment and planning to achieve universal health coverage (on behalf of the government and parliament); improved communication among all stakeholders engaged in the health system; decentralization and regionalization of decisions; and capacity building to use HTA in organizations outside the MOHME. High inflation and bad economic situation; poor transparency in decisions; lack of support from insurance companies; lack of sufficient data to conduct HTA research; rapid change of managers in the health system; and economic sanctions against Iran are threats to the developmental path of HTA in Iran. Conclusion: HTA can be properly developed in Iran if we use its strengths and opportunities, and address its weaknesses and threats.
MeSH term(s)	Humans ; Iran ; Technology Assessment, Biomedical ; Health Policy ; Government Programs ; Communication
Language	English
Publishing date	2023-03-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0283663
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Article: The role of Iran's context for the development of health technology assessment: challenges and solutions.

Behzadifar, Meysam / Behzadifar, Masoud / Saran, Maryam / Shahabi, Saeed / Bakhtiari, Ahad / Azari, Samad / Bragazzi, Nicola Luigi

Health economics review

2023 Volume 13, Issue 1, Page(s) 23

Abstract: Health technology assessment (HTA) is a comprehensive and structured evaluation that aims to analyze the potential impacts of health technologies, including medical devices, diagnostic tools, pharmaceuticals, and public health interventions. Its purpose ... ...

Abstract	Health technology assessment (HTA) is a comprehensive and structured evaluation that aims to analyze the potential impacts of health technologies, including medical devices, diagnostic tools, pharmaceuticals, and public health interventions. Its purpose is to provide policymakers with evidence-based information to inform decisions related to the utilization and implementation of these technologies. HTA allows for the comparison of various scenarios related to a technology across a wide range of factors. This can aid in the creation of an essential drug list and health benefits package that is tailored to the actual needs of the community within a given healthcare system. In the present paper, we review the role of Iran's context for the development of HTA, in terms of challenges and solutions.
Language	English
Publishing date	2023-04-20
Publishing country	Germany
Document type	Letter
ZDB-ID	2634483-X
ISSN	2191-1991
ISSN	2191-1991
DOI	10.1186/s13561-023-00438-7
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Article: Cost-Effectiveness of Remote Cardiac Monitoring With the CardioMEMS Heart Failure System: A Systematic Review.

Azari, Samad / Mousavi, Seyed Hosein / Markazi Moghaddam, Nader / Rezapour, Aziz / Zargar Balaye Jame, Sanaz / Kolivand, Pirhossein / Sarabi Asiabar, Ali

Medical journal of the Islamic Republic of Iran

2023 Volume 37, Page(s) 16

Abstract: Background: Heart Failure (HF) imposes a relevant burden and a considerable health concern, with high prevalence and mortality rates. This study was conducted to assess the cost-effectiveness of remote cardiac monitoring with the CardioMEMS Heart ... ...

Abstract	Background: Heart Failure (HF) imposes a relevant burden and a considerable health concern, with high prevalence and mortality rates. This study was conducted to assess the cost-effectiveness of remote cardiac monitoring with the CardioMEMS Heart Failure System. Methods: In the present systematic review, several scholarly databases were searched and updated from inception up to September 20, 2022. The objective of the present review was formulated according to the patient/population, intervention, comparison and outcomes format. Mortality rate, hospitalization rate, quality-adjusted life year (QALY), total costs, and the incremental cost-effectiveness ratio regarding the use of the CardioMEMS System were the key outcomes of the present study. The quality of included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS) checklist. Results: Finally, 5 articles were retained and analyzed in the present systematic review. All studies employed the Markov and decision tree models. Results show that the CardioMEMS system reduced mortality and hospitalization rate and created a higher QALY. In all selected countries the CardioMEMS method is a more expensive method than the standard of care (SoC), with the highest cost in the United States (US) ($201,437) and the lowest cost in the United Kingdom ($25,963), respectively. the highest willingness to pay in the US and the lowest in Italy ($100,000 and $33,000 per QALY), respectively. Results showed that the most cost per QALY for the CardioMEMS system was in the US and the lowest was in the Netherlands ($46,622 and $26,615 per QALY), respectively. Conclusion: In all selected countries, CardioMEMS is a cost-effective method for monitoring and managing pulmonary artery pressures in HF patients. Strategies such as CardioMEMS, which decrease the rate of hospitalization, are likely to be only more cost-effective in the future.
Language	English
Publishing date	2023-04-04
Publishing country	Iran
Document type	Journal Article ; Review
ZDB-ID	1095990-7
ISSN	1016-1430
ISSN	1016-1430
DOI	10.47176/mjiri.37.16
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Article ; Online: Cost-Effectiveness of Atrial Fibrillation Screening Strategies: A Systematic Review.

Abolghasem Gorji, Hassan / Khosravi, Majid / Mahmoodi, Razieh / Hasoumi, Mojtaba / Souresrafil, Aghdas / Alipour, Vahid / Rezapour, Aziz / Hajahmadi, Marjan / Azari, Samad

Iranian journal of public health

2022 Volume 52, Issue 4, Page(s) 672–682

Abstract: Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia. AF is associated with an increased risk of stroke. We aimed to review systematically the cost-effectiveness of screening strategies for patients with AF.: Methods: To find ... ...

Abstract	Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia. AF is associated with an increased risk of stroke. We aimed to review systematically the cost-effectiveness of screening strategies for patients with AF. Methods: To find related research and articles, articles published in Iranian and international databases by using a combination of MeSH (Medical Subject Headings) terms and based on inclusion and exclusion criteria were searched and reviewed until Dec 2020. The main outcome measures of the final articles were incremental cost-effectiveness ratios (ICER) per gained or additional quality-adjusted life years (QALYs), additional case detected, and avoided stroke. Results: Out of 3,360 studies found, finally, fifteen studies were included in the research. The lowest ICER numerical value was 78.39 for AF screening using ECG for 65-85 yr old Japanese women. The highest value of this index is equal to 70864.31 for performing ECG monitoring for more than 60 d for Canadians over 80 yr without AF history. In two studies, the results were expressed with the years of life gained (YLG measure. Of course, in one study, the results were not reported with this measure, and in one study, the results were reported with ICER. Conclusion: Most of the studies acknowledged the cost-effectiveness of different AF screening strategies. However, studies that confirmed the cost-effectiveness of population-based screening were more than studies that confirmed the cost-effectiveness of other screening strategies.
Language	English
Publishing date	2022-08-31
Publishing country	Iran
Document type	Journal Article ; Review
ISSN	2251-6093 ; 0304-4556
ISSN (online)	2251-6093
ISSN	0304-4556
DOI	10.18502/ijph.v52i4.12435
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Article: Cost-Effectiveness of Sacubitril/Valsartan Compared with Enalapril in Patients with Heart Failure with Reduced Ejection Fraction: A Systematic Review.

Rezapour, Aziz / Azari, Samad / Arabloo, Jalal / Kolivand, Pirhossein / Behzadifar, Masoud / Omidi, Negar / Sarabi Asiabar, Ali / Saberian, Peyman / Pourasghari, Hamid / Bragazzi, Nicola Luigi / Mehrani, Mehdi / Shahi, Shayan / Tajdini, Masih

The journal of Tehran Heart Center

2023 Volume 17, Issue 4, Page(s) 168–179

Abstract: Background: To assess the cost-effectiveness of sacubitril/valsartan compared with enalapril in patients with heart failure with reduced ejection (HFrEF).: Methods: A systematic literature search was conducted searching in major electronic databases ... ...

Abstract	Background: To assess the cost-effectiveness of sacubitril/valsartan compared with enalapril in patients with heart failure with reduced ejection (HFrEF). Methods: A systematic literature search was conducted searching in major electronic databases from inception to January 1, 2021. All relevant full economic evaluation studies of sacubitril/valsartan versus enalapril for the treatment of patients with HFrEF were identified using ad hoc search strategies. Mortality, hospital admissions, quality-adjusted life years (QALYs), life-years (LYQs), annual drug costs, total lifetime costs, and incremental cost-effectiveness ratio (ICER) were considered as the outcomes. The quality of the included studies was assessed using the CHEERS checklist. This study was conducted and reported in accordance with the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) guidelines. Results: The initial search yielded a pool of 1026 articles, of which 703 unique articles were screened, 65 full-text articles were assessed for eligibility and 15 studies finally included in the qualitative synthesis. Studies show that sacubitril/valsartan reduces mortality and hospitalization rate. The mean of death risk ratio and hospitalization were computed at 0.843 and 0.844, respectively. Sacubitril/valsartan produced higher annual and total lifetime costs. The lowest and highest lifetime costs for sacubitril/valsartan were found in Thailand ($4,756) and Germany ($118,815), respectively. The lowest ICER was reported in Thailand ($4857/QALY) and the highest in the USA ($143,891/QALY). Conclusion: Sacubitril/valsartan is associated with better outcomes and may be cost-effective compared to enalapril for the management of HFrEF. However, in developing countries such as Thailand, sacubitril-valsartan costs must be reduced to yield an ICER below the threshold.
Language	English
Publishing date	2023-05-04
Publishing country	Iran
Document type	Journal Article ; Review
ZDB-ID	2476998-8
ISSN	2008-2371 ; 1735-5370 ; 1735-8620
ISSN (online)	2008-2371
ISSN	1735-5370 ; 1735-8620
DOI	10.18502/jthc.v17i4.11603
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