Health Technology Assessment in Action

Economic Evaluation of Sacubitril/Valsartan in Chronic Heart Failure Patients: A Markov Model Analysis in Iran

Mahmood Yousefi — 2025-12-23

Background: Sacubitril/valsartan (Sac-Val) is recommended for patients with heart failure (HF) and reduced ejection fraction (HFrEF). This study aimed to evaluate the cost-effectiveness of Sac/Val in chronic HF patients in Iran.
Methods: A Markov model was constructed to assess the cost-effectiveness of Sac/Val and enalapril from a healthcare perspective over a 15-year time horizon. The primary outcome was the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life year (QALY). A discount rate of 3.5% was applied to both costs and outcomes, and a probabilistic sensitivity analysis was performed to evaluate the robustness of the results.
Results: The average costs of treating HF patients with Sac/Val and enalapril were 22,132,050,140 IRR (USD 77,442.3) and 143,043,859 IRR (USD 500.52), respectively, whereas the corresponding QALY values were 5.37 and 3.30, respectively. Sac/Val was more expensive and more effective than enalapril. The ICER was 10,635,189,214 IRR per QALY (37.06 USD/QALY), which was higher than the WHO-recommended threshold in terms of gross domestic product per capita in 2022. Sac/Val had a significant impact on increasing the QALY for HFrEF patients. At the proposed price, the cost per QALY value for Sac/Val exceeded the recommended threshold for the country.
Conclusion: Considering the country’s economic context, negotiating lower prices for Sac/Val would bring it to the top of the priority list for health services.

Cost Analysis of Diagnosis and Treatment of Venous Thromboembolism in Total Knee Replacement Patients

Hadi Alizadeh siuki — 2025-12-23

Background: Venous thromboembolism (VTE) is a condition that occurs when a blood clot forms in a vein. It includes deep vein thrombosis (DVT) and pulmonary embolism (PE). VTE treatment incurs substantial costs, and it is predicted that the economic burden of this disease on society will continue to rise both domestically and globally. This study aimed to analyze the costs associated with the diagnosis and treatment of VTE in patients undergoing total knee replacement in order to identify major cost drivers and provide insights for more efficient healthcare management.
Methods: An incidence-based approach was used in this cross-sectional descriptive study to perform the cost analysis of diagnosis and treatment of VTE in total knee replacement patients in Iran in 2023. To this end, direct costs were calculated based on the bottom-up costing approach.
Results: The average direct medical cost per patient was $1742.65. The average direct non-medical cost per patient was estimated at $604.75. Notably, 44% of these costs are associated with patient companionship, while 33% are attributed to transportation costs.
Conclusion: With the elderly population on the rise in our country, the need for knee joint replacement surgeries is on an upward trajectory as well. However, it is associated with the risk of developing VTE, which can be severe and life-threatening. Moreover, patients who develop VTE after major orthopedic surgeries tend to have considerably longer hospital stays, placing a strain on hospital resources and finances.

Quality of Life and Utility Values in Iranian Colorectal Cancer Patients: Using Generic and Specific Instruments

Nazila Yousefi — 2025-12-23

Background: Health-related quality of life (HRQoL) is a key indicator in evaluating healthcare outcomes. Given the rising prevalence and high treatment costs of colorectal cancer (CRC) in Iran, assessing patients’ HRQoL is crucial for guiding health policy and effective resource planning. Accordingly, this study aimed to evaluate the QoL of CRC patients in Iran.
Methods: The population of this study included 60 CRC patients (30 cases in the stable state and 30 cases in the progressive state of the disease), who had been referred to hospitals affiliated with Shahid Beheshti University of Medical Sciences in 2019-2020. The patients’ QoL was estimated using EQ-5D-VAS, QLQ-CR29, and QLQ-C30 questionnaires.
Results: The mean VAS score was 0.62 ± 0.07, and the patients’ mean QLQ-CR29 and QLQ-C30 scores were 38.80 ± 9.70 and 48.90 ± 12.10, respectively. Moreover, the utility value of EQ-5D for the EQ-5D health states in the stable and progressive groups was 0.87 ± 0.11 (VAS: 0.82 ± 0.15) and 0.36 ± 0.30 (VAS: 0.44 ± 0.28). The results confirmed a significant difference (P < 0.001) between the two groups. Additionally, having an ostomy, rectal cancer, higher stages of cancer, and metastasis was significantly (P < 0.05) associated with a decreased QoL.
Conclusions: Overall, the QoL of CRC patients in Iran was comparable to that of the general population in stable stages but significantly decreased with disease progression. Consistent findings across EQ-5D, QLQ-C30, and QLQ-CR29 highlight reduced utility in advanced and metastatic cases. Compared with global studies, Iranian patients demonstrated similar or slightly lower QoL, indicating the need for local data in health economic evaluations.

Economic Burden of Diabetic Nephropathy in the Southwest of Iran

Saeed Bagheri Faradonbeh — 2025-12-23

Background: Diabetic nephropathy (DN) is a common complication of diabetes that, given the increasing prevalence of diabetes, imposes a serious economic burden on healthcare systems and societies. Therefore, this retrospective cross-sectional study aimed to estimate the economic burden of DN and identify factors influencing its cost in Iran.
Methods: Overall, 192 patients with DN were selected from Imam Khomeini and Golestan Hospitals in Ahvaz and then categorized into mild, moderate, and severe stages based on their glomerular filtration rate. Direct medical costs were obtained from hospital billing records, while non-medical and indirect costs were recorded through interviews with patients and their caregivers. Finally, the obtained data were analyzed by Microsoft Excel 2019 and Stata 16 using logistic regression models.
Results: The total cost of managing patients with DN was estimated at 839,083.88 PPP (current international dollars). Moreover, direct costs accounted for 88.2% of the total cost, of which 83.9% were medical, while 16.1% were non-medical. The logistic regression analysis demonstrated that education (odds ratio: 3.655, P = 0.044) and disability (odds ratio: 0.722, P < 0.001) were significantly associated with diabetes-related costs.
Conclusions: It was revealed that DN imposes a substantial economic burden on adults with type 2 diabetes. Thus, effective diabetes control and complication prevention strategies can help reduce these costs and alleviate the economic strain on both patients and the healthcare system.

Comparison of Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block with Ilioinguinal and Iliohypogastric Nerve Block for Postoperative Pain Relief in Open Inguinal Hernia Surgeries: A Randomized Clinical Study

Swarna Banerjee — 2025-12-23

Background: Transverse abdominis plane (TAP) blocks and ultrasound-guided (USG) ilioinguinal/iliohypogastric (II/IH) nerve blocks (NBs) are frequently utilized for postoperative analgesia following inguinal hernia repair (IHR). This study evaluated the effectiveness of II/IH NBs as postoperative analgesics in patients having IHR surgeries.
Methods: This randomized, controlled, double-blind study was conducted at a tertiary care teaching hospital in eastern India. Overall, 60 patients satisfying the inclusion criteria were selected and randomly divided into groups S, T, and I. All patients received spinal anaesthesia (SA). Patients in group S received only SA, while patients in group T received a TAP block immediately after SA. Finally, patients in group I received II/IH NB post-SA.
Results: The time to first rescue dose was the highest in the SA with the II/IH block group (283 ± 17.1), followed by SA with the TAP block group (266.3 ± 22.1) and SA alone (127 ± 20.8). All differences were statistically significant at P < 0.05. Group S received the highest number of rescue analgesia doses. Furthermore, patients in groups T and I needed almost a similar number of rescue doses (P = 0.17).
Conclusion: There was no significant difference in the mean duration of surgery in all three groups. Moreover, the visual analog scale (VAS) score for pain was similar in all three groups at different observation points, except at 2 hours and 6 hours post-surgery. At 2 hours post-surgery, patients belonging to group S had significantly higher VAS scores.

Key Factors and Requirements of Medical Centers to Enter the Medical Tourism Industry in Iran

Mehdi Raadabadi — 2025-12-23

Background: According to the World Tourism Organization, the tourism sector will significantly influence the global economy and international trade, especially from 2020 to 2030, with medical tourism emerging as the largest and fastest-growing economic sector worldwide. This research focused on pinpointing and ranking essential factors and requirements of medical centers to engage in the Medical Tourism Industry in Iran.
Methods: This study was conducted using a mixed qualitative and quantitative approach. The sample included 40 experts in tourism and medical tourism who were selected purposefully. Data collection was conducted using a researcher-made form and a structured questionnaire for prioritizing. Qualitative content analysis and analytic hierarchy process (AHP) were used to analyze data. The obtained data were analyzed using Expert Choice software version 11.
Results: In the first phase, 210 codes were identified, which were grouped into 6 categories and 40 actors. These categories included policy, economic, information and marketing, human, health infrastructure, and diversity and quality of health services. The greatest weight or priority was related to diversity and quality of health services, with a weight of 0.352, while the lowest weight or priority was
related to information and marketing, with a weight of 0.011.
Conclusions: Iran can make its role in this market more prominent by investing as much as possible in its strengths and introducing them as its unique capabilities in providing services. In terms of points that can be corrected, it is possible to achieve the desired result by compiling comprehensive plans, marketing, and modifying some processes.

Policy Perspectives of Health Technology Assessment in Ethiopia: Review

Desalegn Ararso Garoma — 2025-12-23

Background: Health technology assessment (HTA) is a topic of increasing interest for all countries. However, policymakers in Ethiopia may face challenges in identifying the grounds on which the HTA process should be established. This review assessed the availability of HTA-related policy documents in Ethiopia to guide the future HTA system.
Methods: A descriptive analysis of HTA-related content was conducted within Ethiopian policy documents. An iterative search of policy documents was carried out from May 1–30, 2021, using organizational websites and advanced Google Scholar searches. Additional documents were obtained by consulting field experts. The synthesis considered the four major policy periods in Ethiopia and specific relevant policy documents.
Results: Review findings were organized according to the four different policy periods, focusing on HTA directions in Ethiopia. The policy recommendations stated in the reviewed documents included: the need to establish a national HTA center, the development of an HTA system, and the formation of an HTA team within the Ministry of Health. In HSTP II, attention was also directed to incorporating HTA and adaptive mechanisms.
Conclusions: When establishing a national HTA system, it is important to consider policy recommendations already stated in existing documents. Special attention should be given to the development of HTA guidelines, strategic documents, and policy documents that can link HTA results to decision-making processes. This could help close the gap between regulatory HTA processes and HTA implementation in Ethiopia. The findings of this review can also be used to inform policy contexts regarding HTA in countries with similar settings.

Advancing Social Marketing in Healthcare: Leveraging the Internet of Behavior Technology to Overcome Data Collection and Analysis Challenges

Zahra Sadeqi-Arani — 2025-12-23

Social marketing aims to address public health challenges by promoting positive behavior change through the application of marketing principles and techniques. This approach involves the creation, communication, and delivery of value-based interventions designed to drive social change and enhance public welfare. By leveraging commercial marketing concepts and tools, social marketing advances social objectives and improves societal well-being. It emphasizes understanding and addressing the needs, wants, and motivations of the target audience to effectively influence behavior. This method involves the systematic planning and execution of campaigns aimed at achieving specific social goals, such as improving health outcomes, promoting environmental sustainability, and encouraging civic engagement. Social marketing plays a crucial role in healthcare by reaching diverse populations, raising awareness, changing attitudes, and ultimately motivating individuals to adopt healthier behaviors. Notable applications include smoking cessation, promoting vaccination uptake, combating obesity and encouraging healthy eating habits, raising mental health awareness and reducing stigma, HIV/AIDS prevention, road safety and injury prevention, controlling the spread of pandemic, and increasing awareness about organ donation.