Vol 3, No 1 (2019)


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    Introduction: The number of studies on health is increasing rapidly worldwide and in Iran. Systematic review studies, meta-analysis, and economic evaluation are of great importance in evidence-based decision making because of their standing in the evidence-based pyramid. The purpose of this study was to evaluate the reporting and methodological quality of Iranian systematic reviews, meta-analysis studies and economic evaluations on healthcare.
    Methods: PubMed and Scopus databases were searched to find considered studies, including systematic reviews, meta-analysis, and economic evaluations published from2005 to 2015. Because of the high volume of review studies, 10% of all systematic reviews and meta-analysis were selected as a random sample. Also, all economic evaluations were included. Articles were evaluated using checklists, including PRISMA, AMSTAR, and QHES with a maximum score of 27, 11 and 100, respectively. The quality score for each criterion as well as the epidemiological and descriptive characteristics of all articles was determined. Data were analyzed using SPSS 16 software.
    Results: After searching the databases, 1084 systematic reviews and meta-analysis were obtained, 10% of which were included in the study. A total of 41 economic evaluations were also included. The mean scores of systematic reviews and meta-analysis based on PRISMA and AMSTAR checklists were 17.04 (5.35) and 5.42 (1.97), respectively, and 68.21 (12.44) for economic evaluations based on QHES. Only three systematic reviews and meta-analysis articles had recorded protocols and 85% of the studies included the terms “systematic review” and “meta-analysis” in their titles. Only one study had been updated. Also, 81% of the systematic reviews and meta-analysis were published in specialized journals and 47% in Iranian journals. Financial resources and conflict of interests had been mentioned in 33% and 66% of the studies, respectively. Of the selected studies, 60% had evaluated the quality of the articles and 35% of the studies had assessed publication bias. In economic evaluations, 56% had used CEA analysis, 22% CUA analysis, 12% CBA analysis, and one study had used CMA analysis. Of these studies, 54% were model-based health economic studies and 12% were trial-based. The economic perspective was the health care system in most studies. Forty-four percent of the studies had a short time horizon of one year or less, whereas 33% had a lifetime horizon. Moreover, 68% of the studies showed sensitivity analysis and only 5 included the magnitude and direction of the bias.
    Conclusion: Overall, the reporting and methodological quality of the selected studies were estimated at a moderate level. Based on these results, it is recommended to adopt strategies to reduce preventable errors in studies. Having a primary plan and protocol and registered it as a systematic review can be an important factor in improving the quality of studies. Economic evaluations should also focus on issues, such as economic perspective, time horizon, available bias, and sensitivity analysis.

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    Context: Patients with hemophilia recieves coagulation factor replacement for lifetime. In iran, on-demand treatment method is used as standard. Clinical studies have shown significant improvements in clinical and economic outcomes as a result of the use of prophylaxis compared with other therapies. The aim of this study was to evaluate safety and efficacy of prophylaxis in patients with severe hemophilia type A and B.
    Evidence Acquisition: This is a systematic review and meta-analysis in order to evaluate the safety and efficacy of prophylaxis treatment in patients with severe hemophilia. To this response, all clinical trials, cohorts, and case-control studies which have been investigated, published 1970 to sep 2017 and the results have been analyzed in STATA.
    Results: 1439 studies were found in primary search and 17 of them had inclusion criteria. The mean annual bleeding  rate in prophylays treatment was 2.8 times per person/year. This study also showed that in prophylaxis, the average incidence of adverse effects was 0.13 cases, and the severe adverse effects was 0.06 cases per person/year. 
    The analysis of the studies entered in this evaluation showed that the adverse effects were significantly lower in patients treated with prophylaxis than in patients treated with on-demand treatment. This difference was observed in severe adverse effect but it was not statistically significant and this shows that prophilaxis is safer than on-demand method. The lower annual bleeding rate in prophylaxis compared with the on-demand treatment method is also a sign of the effectiveness of prophilaxis.

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    Context: Growth hormone deficiency (GHD) is one of the most important reasons of short stature in children, which can be treated by early diagnosis. Stature is a good measure for assessing a child's overall growth and health, and height can affect one's psychosocial and social well-being. Human Growth Hormone (HGH) has extensive effects on biological processes, and helps to influence height. Due to the high cost of growth hormone GH drugs, in most countries it is prescribed according to scientific indications.
    Methods: The present study is a systematic review. From the beginning of 2002 to February 2019, by searching Web of Science, PubMed, Scopus, SID, Embase and Magiran databases, related studies in the scope of health technology assessment and Economic evaluation were reviewed. Finally, 11 related studies were entered the study.
    Results: The use of GH therapy was effective in increasing the patients' life quality. The growth of children treated with GH was more than 2.5 cm per year more than untreated children. Furthermore, the results of the studies indicated the cost-effectiveness of using GH. So that the cost of each centimeter increase in height is on average US $ 20,000, and the incremental cost-effectiveness based on QALY's criteria in studies for various indications (Turner syndrome, idiopathic short stature, growth hormone deficiency, Prader Willi syndrome , Infants small for gestational age (SGA), chronic renal failure (CRF) and (SHOX-D) is different. The highest cost efficacy per kali is for growth hormone deficiency (from £ 20,000 to £ 30,000) and the lowest cost efficacy is for Prader Willi (from £ 55,000 to £ 135,000).
    Conclusions: Studies showed that GH increases the height of the children treated with GHD, compared to the control children; hence, the use of growth hormone is recommended after doing the experiments for all children with GHD. This issue can be considered by health policy makers to implement in healthcare programs.

Review Article

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    Context: Cone-Beam Computed Tomography (CBCT) is a medical imaging technology with various dental applications, and diagnosis of oral and maxillofacial lesions. The main purpose of the study is to update safety and efficacy of CBCT technology.
    Materials and Methods: Since the time searching in the previous report was up to December 2010, electronic databases including Cochrane and Scopus have been searched from January 2011 to June 2014. In the first step, based on inclusion and exclusion criteria, title, abstract and full-text of articles were reviewed by two independent reviewers. In some cases, the full-text of articles was not available, so contact with author of article and the full-text was obtained. Also, non-English language articles were excluded from this study. At the next stage, all final papers were critically appraised and appropriate data were extracted. We have used the designed form in the previous report to extract data and information on the included articles. Due to the heterogeneity in studies, results were reported in descriptive and qualitative manners.
    Results: After removing duplicate articles, a total of 876 articles were included in this study. Finally, 23 studies were reached the final analysis stage. In terms of quality, 13 articles were of average quality and 10 articles were of good quality. Most of the studies have been related to Iran (5 cases), Brazil (4 cases), Germany (3 cases), Britain, USA and, Netherlands (each country has 2 studies) and, Turkey, China, India and, Switzerland (each country has 2 studies). The included studies have been conducted in 2011 (8 cases), 2012 (6 cases), 2013 (5 cases) and, 2014 (4 cases), respectively. 1806 samples were reviewed in all included studies. Most of important reported cases include sensitivity, specificity, accuracy, positive and negative predictive value, and under area curve. 86.3% of the studies reported sensitivity and specificity (19 studies), accuracy (8 studies), area under the curve (8 studies). Positive and negative predictive values were 36.3% and 27.2%, respectively.
    Conclusions: CBCT imaging is highly sensitive to the diagnosis of various types of lesions in oral. However, due to the limit number of clinical trials and the lack of evidence, further studies are needed to make stronger decisions.

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    Context: Recent advances in information technology and electronic devices, as well as limitations in traditional education, have persuaded higher education systems to use the virtual model as an alternative. The present systematic review aimed at evaluating the cost-effectiveness of both the traditional and virtual education models.
    Methods: In this systematic review, articles published in known English and Persian databases, such as MEDLINE (PubMed), Scopus, Science Direct, HTA, Cochrane, Irandoc, Magiran, and SID from 2007 to 2017 were retrieved. Studies on health technologies and economic were also reviewed. For this purpose, the hierarchical search algorithm and the keywords “e-Learning” and “traditional education” were used.
    Results: Ten studies were included, and their results were slightly different. Most studies showed that the cost-effectiveness of virtual education alone or in combination with traditional education (blended model) was equal or greater than that of traditional education. The data analysis of the articles was performed by comparing cost, effectiveness (Min, SD, QASE), cost-effectiveness (ICER), and the average cost per student. Cost-effectiveness refers to achieve the highest output at the lowest cost. The results showed that due to the use of multimedia, lack of space and time limitations, admission of a large number of students, the increased student satisfaction, easy and fast access to information, and use of Sharable Content Object Reference model in producing content and instruction, distance higher education reduces education costs while compensating for the lack of human resources in the teaching-learning process.
    Conclusion: One of the effective methods in the education of medical students seems to be Web-based teaching as traditional teaching. Considering the predominance of the web-based method, it is recommended to be used in educational programs in the universities.