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This study aimed to explore the strengths and weaknesses of e-learning during the COVID-19 pandemic from the perspective of its primary stakeholders, namely professors and students, and to provide practical solutions. Design is a qualitative study. We enrolled 22 faculty members and 58 students purposively. Research data were collected through a data collection checklist and via email and continued until the data were saturated. The qualitative content analyses were the basis of analysis in this study. Strengths were presented in 6 themes and 26 subthemes, weaknesses in 5 themes and 23 subthemes, and solutions were presented in 5 themes and 20 subthemes. Save money, time and energy; use modern software and educational technologies; and the ability to individualize education were among the strengths of e-learning. The most important weaknesses related to e-learning include infrastructure difficulties, problems related to the ability of professors and students to use educational systems. The most beneficial solutions offered included improving and upgrading the e-learning infrastructure, empowering professors and students to use educational systems. We concluded that using online teaching has many strengths as well as some weaknesses. Identifying these strengths and weaknesses can help policymakers plan better.

The EQ-5D is the most popular generic preference-based instrument used for asthma patients. This study aims to explore the psychometric properties of the EQ-5D-5L instrument in patients with asthma and identify the EQ-5D-5L scores in these patients.PubMed, Scopus, Web of Science, Google Scholar and CEA Registry were searched with English language from 2009 until April 2020. Retrieved studies were checked against the inclusion criteria. Reference lists of the included articles were also reviewed. The quality of included articles was evaluated using Mitton checklist and the data were extracted by a reviewer and were checked by a second reviewer. Meta-analysis was done to calculate the overall scores based on type of asthma control.A total of 17 articles were included. The EQ-5D-5L scores ranged from 0.45 to 0.93 and the VAS scores ranged from 35.67 to 83.80. The EQ-5D-5L is higher in well-controlled (0.88, 95% CI: 0.81-0.96,Higher score of the EQ-5D-5L was consistent with well-controlled asthma patients and those with lower severity of asthma. The assessment of psychometric properties of the EQ-5D-5L needs further observations.

Background and aims The psychometric properties of the EQ-5D-3L (a generic preference-based instrument used for calculating quality-adjusted Life –years) have not been known for any type of disease in Iran. This study aimed to assess its validity and reliability in patients with type 2 diabetes. Methods Data of 579 patients were collected from the Diabetes Research Center and Clinics in Yazd using EQ-5D-3L, SF-36, and DQoL instruments. The ceiling effects were computed for the EQ-5D-3L index and EQ VAS. The construct validity was assessed by using convergent validity, discriminant validity, and known-groups validity. Reliability was assessed using Cohen’s kappa value, Cronbach’s alpha, and intra-class correlation coefficient. Results The ceiling effects of EQ-5D-3L and EQ VAS were 20.18% and 15.33%, respectively. The highest degree of correlation was found between the pain/discomfort of EQ-5D and the BP scale of the SF-36 (0.55). Higher scores of all scales of the DQoL were associated with patients reporting no problems in each EQ-5D dimension. The mean of EQ-5D-3L index and EQ VAS scores were significantly higher in the male, married, and employed patients, and they did not have retinopathy, nephropathy, IHD, hypertension, DFU. The range of kappa values was from 0.39 to 0.71, and value of ICC for the EQ-5D-3L index and EQ VAS was 0.76 and 0.64, respectively. Cronbach’s alpha was 0.87 for EQ-5D-3L and 0.74 for EQ VAS. Conclusions Our findings demonstrated good construct validity and moderate to good levels of reliability of the EQ-5D-3L for using in the patients with diabetes, and it can be used in research or clinical practice in Iran and other regions of the Middle East.

Background: Short-Form Six-Dimension version 2 (SF-6Dv2) is a multi-attribute utility instrument that can be used in combination with the SF-36v2 (SF-6Dv2SF-36) or as an independent instrument in t...

Objectives Health-related quality of life (HRQoL) is one of the most important outcome measures for patients. The purpose of this study was to evaluate HRQoL and related factors in Coronavirus disease 2019 (COVID-19) patients. Methods A total of 420 COVID-19 patients who had been discharged from hospital were selected using a systematic sampling. The EuroQol 5-dimensional-5 levels (EQ-5D-5L) questionnaire along with medical records of the patients were used to gather the data. The t test and analysis of variance were employed to test the difference between mean EQ-5D-5L scores, and the BetaMix model was used to investigate factors associated with EQ-5D-5L scores. Results The mean score for the patients who completed the EQ-5D-5L questionnaire (n = 409) was 0.6125. The EQ-5D-5L scores were significantly higher in males, patients with younger age, those with a low level of education, the employed, patients who worked in uncrowded workplaces, patients without diabetes, and those who were not admitted to intensive care unit. The BetaMix model showed that gender, age, education, employment status, having diabetes, heart failure, and admission to the intensive care unit were significant independent predictors of the EQ-5D-5L index values. Conclusion The mean score for EQ-5D-5L in COVID-19 patients was low in this study. Some of the factors, especially aging and having diabetes, should be considered in the aftercare of patients to improve their HRQoL.

The EQ-5D-5L and two versions of the SF-6D version 2 (i.e., SF-6Dv2ind-10 that is derived from 10 items of the SF-36v2, and SF-6Dv2SF-36 that is derived from its combination with the full SF-36v2) are used to drive utilities. The study was prospected to compare the performance of these instruments in breast cancer patients. Data were gathered from 418 patients with breast cancer using three questionnaires including the EQ-5D-5L, SF-36v2, and SF-6Dv2ind-6. The differences between the mean utilities of instruments were tested by t-test. The correlation between the dimensions scores of instruments was estimated by Spearman’s correlation coefficient (ρ). The level of agreement between the instruments score was assessed by ICC and Bland–Altman plot. The correlations between theoretically related pairs of EQ-5D-5L and SF-6Dv2SF-36 were stronger than those of the EQ-5D-5L and SF-6Dv2ind-6. The ICC between EQ-5D-5L and SF-6Dv2ind-6 was 0.64, and between EQ-5D-5L and SF-6Dv2SF-36 was 0.48. The Bland–Altman plot showed that there was a poorer agreement on the lower values. The EQ-5D-5L had more similarity with the SF-6Dv2ind-6 in comparison with the SF-6Dv2SF-36. Nevertheless, there are still significant differences between them.

The health-related quality of life (HRQoL) data extracted from cancer-specific questionnaires are often non-preference based, while patient preference-based utility data are required for health economic evaluation. This study aimed to map Functional Assessment of Cancer Therapy-Breast (FACT-B) subscales onto the Short Form six Dimension as an independent instrument (SF-6Dv2ind-6) using the data gathered from patients with breast cancer. Data for 420 inpatient and outpatient patients with breast cancer were gathered from the largest academic center for cancer patients in Iran. The OLS and Tobit models were used to predict the values of the SF-6Dv2ind-6 with regard to the FACT-B subscales. Prediction accuracy of the models was determined by calculating the root mean square error (RMSE) and mean absolute error (MAE). The relationship between the fitted and observed SF-6Dv2ind-6 values was examined using the Intraclass Correlation Coefficients (ICC). Goodness of fit of models was assessed using the predicted R2 (Pred R2) and adjusted R2 (Adj R2). A tenfold cross-validation method was used for validation of models. Data of 416 patients with breast cancer were entered into final analysis. The model included main effects of FACT-B subscales, and statistically significant clinical and demographic variables were the best predictor for SF-6Dv2ind-6 (Model S3 of OLS with Adj R2 = 61.02%, Pred R2 = 59.25%, MAE = 0.0465, RMSE = 0.0621, ICC = 0.678, AIC = -831.324, BIC = -815.871). The best algorithm developed for SF-6Dv2ind-6 enables researchers to convert cancer-specific instruments scores into preference-based scores when the data are gathered using cancer-specific instruments.

Purpose Cardiovascular diseases (CVDs) are the major causes of mortalities worldwide. This study was conducted to evaluate the direct and indirect costs of coronary artery disease (CAD) in Iran. Patients and methods This is a prevalence-based cost-of-illness (COI) study that estimates the direct and indirect costs of CAD. The study conducted over a six-month period from April to September in 2017. Patients were recruited from Madani hospital in Tabriz, Iran. A total of 379 patients were investigated from societal perspective. Direct costs were estimated using the bottom-up costing approach and indirect costs were estimated using the Human Capital (HC) approach. A generalized linear model of regression was used to explore the relation between total cost and socio-demographic variables. The total annual mean cost was compared to Gross Domestic Product (GDP) per capita which was reported in the form of Purchasing Power Parity (PPP) index. To deal with uncertainty, one-way sensitivity analysis was performed. Results Total costs per patient in one year were estimated to be IRR 63452290.17 ($PPP 7736.19) at a 95% confidence interval (58191511.73-68713068.60), the biggest part of which is related to direct medical costs with IRR 33884019.53 per year ($PPP 4131.18) (54%). Direct non-medical costs were estimated IRR 1655936.68 ($PPP 201.89) per patient (2%) and indirect costs were estimated IRR 27912333.97 per patient ($PPP 3403.11) (44%), which 62% of indirect costs is related to patients' work absenteeism. Conclusion This study estimates the direct (56%) and indirect (44%) costs associated with CAD. The study explores the essential drivers of the costs and provides the magnitude of the burden in terms of the share of GDP. The outcomes can be used in priority setting, in particular for cost benefit analysis, and adopting new policies regarding insurance coverage and equity issues.

This study systematically reviews the validity, reliability, and responsiveness of the EQ-5D-5 L in studies of T2DM. Relevant articles were retrieved by searching four databases, namely, the Web of Science, Scopus, PubMed, and Cochrane Library up to November 2020 with English language. All stages of the review conducted by two authors and disagreements were solved by consultation with a third reviewer. Of the 1614 identified studies, 46 were remained for review. The EQ-5D-5 L mean scores ranged from 0.314 (0.4) (n = 141) for diabetic patients undergoing hemodialysis to 0.971 (0.082) (n = 56) for diabetic patient without retinopathy. Mean EQ-5D-5 L scores in men (0.847) were higher those in women (0.747). Construct validity and reliability was confirmed in the studies that reported the properties of the EQ-5D-5 L, and responsiveness reported in a study that was good. There were ceiling effects in seven studies. The overall utility value was higher in Japan (0.86, 95% CI: 0.80–0.92, p = 0.0001) thanCanada (0.79, 95% CI: 0.78–0.80, p = 0.81), and the United Kingdom (0.72, 95% CI: 0.64–0.79, p = 0.0001). Findings demonstrated validity, reliability of the EQ-5D-5 L in T2DM and the existence of ceiling effects. However, the assessment of responsiveness and sensitivity needs further observations.

Calculating utility values in colorectal cancer (CRC) patients under chemotherapy treatment is important for studies of economic evaluations. The EQ-5D-5L and composite time trade-off (cTTO) were used to calculate utility values in 105 patients with CRC in Iran. The mean EQ-5D-5L index and cTTO values were 0.45 ± 0.03 and 0.51 ± 0.02, respectively. Anxiety and pain were the most common problems reported by the patients. The BetaMix showed that lower mean utility values were significantly associated with females, aging, a low level of income, a greater number of comorbidities, and an advanced stage of cancer.

Objective: In this review, we investigated various aspects of Policy Delphi technique to make decision-makers more aware of this pertinent method so that they can use it in their policy decisions in their organizations. Information sources and selected methods for study: This study was conducted using a review method and by searching the related literature in databases such as PubMed, Scopus and Google Scholar. In addition, texts in related books or reports were also used. The most important keywords were Policy Delphi, decision making tools, health policy making, decision making, and health. Results: Unlike the traditional Delphi, which seeks consensus on ideas and is a decision-making tool, Policy Delphi is a useful tool for analyzing the policy issues and is more about identifying the opposing views on a policy issue. Policy Delphi seeks to address the policy-related issues and does not seek to reach consensus. In various texts, 6 steps were introduced to this approach: formulating the issues, exposing the options, determining initial positions on the issues, exploring and obtaining the reasons for disagreements, evaluating the underlying reasons, and reevaluating the options. The most important rating scales included desirability, feasibility, importance, and confidence. Conclusion: Application of Policy Delphi in examining policy changes and policy issues is of high importance and can emerge many unintended and negative consequences for a policy. So, it is recommended to use this tool in the health sector due to its wide setting and complexity and since it has different stakeholders with different views and opinions.

Direct and indirect preference-based methods are two main types of utility generating methods which are being frequently used in cost-utility analysis. However, a key question is how do these two methods perform in terms of validity? The aim of this study is to assess the utilities derived from EuroQol five-dimensional 5 level (EQ-5D-5L) as an indirect method and composite time trade-off (C-TTO) as a direct method in patients with colorectal cancer (CRC). A total of 223 patients with CRC were consecutively selected from three cancer centers in Tehran between May and September 2017. The EQ-5D-5L and C-TTO methods were used to estimate utilities in patients. Wilcoxon test was performed to compare utilities between C-TTO and EQ-5D-5L. In addition, intraclass correlation coefficient (ICC) and Bland–Altman plot were used to assess the agreement between the two methods. Bootstrapping quantile regression analysis was performed for comparison coefficient. The mean values of EQ-5D-5L (0.7186 ± 0.1275) for all stages were significantly higher than the C-TTO (0.4180 ± 0.4670) values. Stage 1 had the highest utility in both C-TTO (0.8167 ± 0.2332) and EQ-5D-5L (0.8339 ± 0.0535), whereas stage 4 had the lowest utility (0.1283 ± 0.5530 and 0.6001 ± 0.1220, respectively). As well, the C-TTO underestimates the values in low level of utilities and overestimates in high level of utilities. The overall ICC between the two methods was 0.50. Our study provides some tentative results about the differences between values of EQ-5D-5L and C-TTO, but clearly more work is needed to be done on this issue.

Patient-level utility data are needed for cost-utility analysis; in oncology, however, the data are commonly gathered using disease-specific questionnaires that are often not appropriate. Present study aimed to derive an algorithm which can map the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) scales and the Colorectal Cancer-Specific Quality Of Life Questionnaire (QLQ-CR29) scales onto the EuroQoL 5-Dimension 5-Level (EQ-5D-5L) values in patients with colorectal cancer (CRC). Using the Ordinary Least Square (OLS) model, a cross-sectional dataset of 252 patients with CRC were gathered from three academic centers of cancer treatment in Tehran in 2017. The predicted R2 (Pred R2) and adjusted R2 (Adj R2) are used to evaluate model goodness of fit. Additionally, mean absolute error (MAE), root mean square error (RMSE), Spearman’s correlation coefficients (ρ), and intraclass correlation (ICC) are applied to assess predictive ability of models. The tenfold cross-validation procedure was applied for validation models. According to the results of our study, the model C4 from EORTC QLQ-C30 was the best predictive model (Pred R2 = 66.57%, Adj R2 = 67.67%, RMSE = 0.10173, MAE = 0.07840). Also, the model R4 from QLQ-CR29 performed the best for EQ-5D-5L (Adj R2 = 48.42%, Pred R2 = 45.54%, MAE = 0.10051, RMSE = 0.12997). The mapping algorithm successfully mapped the EORTC QLQ-C30 and QLQ-CR29 scales onto the EQ-5D-5L values; therefore, it enables policymakers to convert cancer-specific questionnaires scores to the preference-based scores.

PurposeThe purpose of present study was to calculate utility values in colorectal cancer (CRC) patients by EQ-5D-5L and cTTO.MethodsThe EQ-5D-5L and cTTO were used to calculate utility values in the patients. A total of 105 patients with CRC were consecutively selected from chemotherapy ward of the Oncology Center of Omid in the second most population province, Isfahan, in Iran. The difference between mean utility values in each factor examined by the t-test and ANOWA. Finally, The BetaMix was used to identify predictors of the utility.ResultsThe mean EQ-5D-5L index and cTTO values were 0.45 ±0.03 and 0.51±0.02, respectively. The anxiety and pain were the most common problems reported by the patients. Univariate analyses showed that the difference between the mean EQ-5D-5L index values were significant for age, education status, income level, stage of cancer, and comorbidity number; also, showed that the difference between the mean cTTO values were significant for age, income level, employment status, stage of cancer, and comorbidity number. The BetaMix showed that lower mean utility values were significantly associated with female, aging, a low level of income, a greater number of comorbidities and advanced stage of cancer.ConclusionThe factors of female, aging, a low level of income, advanced stage of cancer, and a greater number of comorbidities should be considered for improving values of utility. In addition, focusing on anxiety/depression through financial and social supports can be critical for the improvement in the quality of life in the patients.

Health-state utility values of diabetic foot ulcer (DFU) patients are necessary for clinical praxis and economic modeling. The purpose of this study was to estimate utility values in DFU patients using the EuroQol-5-dimension-5-level (EQ-5D-5L) and composite time trade-off (cTTO). The EQ-5D-5L and cTTO were used for estimating utility values. Data were collected from 228 patients referred to the largest governmental diabetes center in the South of Iran, Yazd province. When appropriate, independent sample t-test or analysis of variance test was used to test the difference in the utility values in each of the demographic and clinical characteristics of the patients. Finally, the BetaMix was used to identify predictors of the utility values. The means of EQ-5D-5L and cTTO values were 0.55( SD 0.21) and 0.67( SD 0.23), respectively. Anxiety and pain were the most common problems reported by the patients. The difference between the mean EQ-5D-5L values was significant for age, grade of ulcer, number of comorbidities, and having complications. In addition, variables of gender, age, grade of ulcer, and having complications were significant predictors of the EQ-5D-5L. The difference between the mean cTTO values was significant for age, employment status, grade of ulcer, number of comorbidities, and having complications. Moreover, variables of gender, age, grade of ulcer, number of comorbidities, and developing complications were significant predictors of cTTO. The current study provided estimates of utility values for DFU patients for clinical praxis and economic modeling. These estimates, similar to utilities reported in other studies, were low. Identifying strategies to decrease anxiety/depression and pain in patients is important to improve the utility values.

Objectives This study aimed to investigate and synthesize the current evidence on knowledge, attitudes, and practices (KAPs) of the general population regarding COVID-19. Study design This is a systematic review and meta-analysis. Methods We conducted a systematic search on PubMed/LitCovid, Scopus, and Web of Sciences databases for papers in the English language only, up to 1 January 2021. We used the Joanna Briggs Institute checklist developed for cross-sectional studies to appraise the quality of the included studies. All stages of the review conducted by two independent reviewers and potential discrepancies were solved with a consultation with a third reviewer. We reported the result as number and percentage. A meta-analysis conducted using a random effect model with a 95% confidence interval. Results Forty-eight studies encompassing 76,848 participants were included in this review. 56.53% of the participants were female. The mean age of the participants was 33.7 years. 85.42% of the included studies were scored as good quality, 12.50% as fair quality, and the remaining (2.08%) as low quality. About 87.5% examined all three components of the KAPs model. The knowledge component was reported as good and poor in 89.5% and 10.5% of the included studies, respectively. Of the studies that examined the attitude component, 100% reported a positive attitude. For the practice component, 93.2% reported satisfactory practice, and 6.8% poor practice. The result of the meta-analysis showed that the overall score of KAPs components about COVID-19 were 78.9, 79.8, and 74.1, respectively. Conclusions This systematic review and meta-analysis showed that the overall KAP components in the included studies were at an acceptable level. In general, knowledge was at a good level, the attitude was positive and practice was at a satisfactory level. Using an integrated international system can help better evaluate these components and compare them between countries. PROSPERO registration code (CRD42020186755).

BackgroundUnderstanding people, physicians, and healthcare workers’ knowledge, attitude, and practices (KAPs) can help to achieve the outcomes of planned behavior. The aim of this study was to investigate and synthesize the current evidence on KAPs regarding COVID-19.MethodsWe conducted a systematic search on PubMed/LitCovid, Scopus, and Web of Sciences databases for papers in the English language only, up to 1 Jul 2020. We used the Joanna Briggs Institute (JBI) checklist developed for cross-sectional studies to appraise the quality of the included studies. All stages of the review conducted by two independent reviewers and potential discrepancies solved with a consultation with a third reviewer. We reported the result as number and percentage. PROSPERO registration code: (CRD42020186755).ResultsFifty-two studies encompassing 49786 participants were included in this review. 45.76% of the participants were male. The mean age of the participants was 32.6 years. 44.2% of the included studies were scored as good quality, 46.2% as fair quality, and remaining (9.6%) as low quality. 30.76% examined all three components of the KAPs model. The knowledge component was reported as good, fair, and poor in 59%, 34%, and 7%, respectively. Of the studies that examined the attitude component, 82% reported a positive attitude, 11% a fairly positive attitude, and 7% a negative attitude. For the practice component, 52% reported good practice, 44% fair practice, and 4% poor practice.ConclusionThis systematic review showed that the overall KAP components in the included studies were at an acceptable level. In general, knowledge was at a good level, the attitude was positive and practice was at a fairly good level. Using an integrated international system can help better evaluate these components and compare them between countries.

ObjectiveOne of the fundamental goals of health sector evolution plan (HSEP) in Iran is to improve household’s financial protection against catastrophic health expenditure (CHE). The aim of this study was to calculate the percentage of CHE after implementing the plan and compare that with CHE before the plan at the same households.MethodsThe data was collected through face-to-face interview during a single visit. The World Health Survey (WHS) questionnaire was completed by 400 households. The relationships between CHE and variables were examined by the Fisher exact tests, and the impacts of variables on CHE were assessed by logistic regression model.ResultsThe exposure of the households to CHE increased from 8.2% in 2011 to 14.25% in 2020, and percentage of the impoverished households due to health expenditures in 2020 was more than that in 2011(4.3% vs. 7.5%). The economic status, dental services and inpatients services were the key factor determining CHE. The most important determinant affecting the exposure to CHE was dental service utilization in 2011(92.64) and 2020(122.68).ConclusionThe results showed a negative incremental change for the households facing CHE in this period. The dental and inpatients services, as well as the presence of member ≥65 years and economic status were the key determining factors for CHE. The services need to be more widely covered by the basic health insurance and households having members ≥65 years and the poor households should be exempted from paying some of the healthcare expenditures for improving financial protection against CHE.

BackgroundCOVID-19, which emerged in December 2019, is the largest pandemic ever to occur. During the early phase, little was known about public awareness relating to Coronavirus disease. This study was designed to determine knowledge, attitudes and practices (KAP) among the Iranian public towards COVID-19.MethodsA cross-sectional online survey was carried out in Iran from 2 March to 8 April 2020 using a self-administered questionnaire on 1,480 people. COVID-19-related KAP questions were adapted from other internationally validated questionnaires specific to infectious diseases.ResultsAll participants were aware of COVID-19. When asked unprompted, 80% of respondents could correctly cite fever, difficulty breathing and cough as signs/symptoms of COVID-19. Most of our sample population knew that by staying at home and staying isolated (95.3%, 95 % CI: 94.2-96.3) as well as constant hand washing and using disinfectants (92.5%, 95 % CI: 91.1-93.8) could prevent COVID-19. However, there was also widespread misconceptions such as the belief that COVID-19 can be transmitted by wild animals (58%, 95 % CI: 55.5-60.5) and by air (48.3%, 95 % CI: 45.7-50.8). Unprompted, self-reported actions taken to avoid COVID-19 infection included hand washing with soap and water (95.4%, 95 % CI: 94.3-96.4), avoiding crowded places (93%, 95 % CI: 91.7-94.3), cleaning hands with other disinfectants (80.9 %, 95 % CI: 78.9-82.9), and covering mouths and noses when coughing and sneezing (76.1 %, 95 % CI: 73.9-78.2). The internet and social media (94.5%, 95 % CI: 93.3-95.6) were the main Coronavirus information sources. However, the most trusted information sources on Coronavirus were health and medical professionals (79.3%, 95 % CI: 77.2-81.3). The majority of participants (77.0%, 95 % CI: 74.8-79.1) wanted more information about Coronavirus to be available.ConclusionOur findings suggest that people’s knowledge and attitude towards COVID-19 at the time of its outbreak was of a high level. Therefore, health systems should use multiple ways, such as mass media, phone applications, electronic, print, and tele-education to increase KAP related to COVID-19.

Purpose Cardiovascular diseases (CVDs) are the major causes of mortalities worldwide. This study was conducted to evaluate the direct and indirect costs of coronary artery disease (CAD) in Iran. Patients and Methods This is a prevalence-based cost-of-illness (COI) study that estimates the direct and indirect costs of CAD. The study conducted over a six-month period from April to September in 2017. Patients were recruited from Madani hospital in Tabriz, Iran. A total of 379 patients were investigated from societal perspective. Direct costs were estimated using the bottom-up costing approach and indirect costs were estimated using the Human Capital (HC) approach. A generalized linear model of regression was used to explore the relation between total cost and socio-demographic variables. The total annual mean cost was compared to Gross Domestic Product (GDP) per capita which was reported in the form of Purchasing Power Parity (PPP) index. To deal with uncertainty, one-way sensitivity analysis was performed. Results Total costs per patient in one year were estimated to be IRR 63452290.17 ($PPP 7736.19) at a 95% confidence interval (58191511.73–68713068.60), the biggest part of which is related to direct medical costs with IRR 33884019.53 per year ($PPP 4131.18) (54%). Direct non-medical costs were estimated IRR 1655936.68 ($PPP 201.89) per patient (2%) and indirect costs were estimated IRR 27912333.97 per patient ($PPP 3403.11) (44%), which 62% of indirect costs is related to patients’ work absenteeism. Conclusion This study estimates the direct (56%) and indirect (44%) costs associated with CAD. The study explores the essential drivers of the costs and provides the magnitude of the burden in terms of the share of GDP. The outcomes can be used in priority setting, in particular for cost benefit analysis, and adopting new policies regarding insurance coverage and equity issues.

Introduction: Economic evaluation of healthcare interventions usually needs accurate data on utility and health-related quality-of-life scores. The aim of this study is to map QLQ-C30 scale score onto EQ-5D-5L and SF-6D utility values in colorectal cancer (CRC) patients. Methods: EQ-5D-5L, SF-6D, and QLQ-C30 were completed by 252 patients with CRC who were referred to three cancer centers in Tehran between May and September 2017. Moreover, OLS, Tobit, and CLAD models were used to predict EQ-5D-5L and SF-6D values. The goodness of fit of models was evaluated using Pred R2 and Adj R2. In addition, their predictive performance was assessed by MAE, RMSE, ICC, MID, and Spearman’s correlation coefficients between observed and predicted EQ-5D-5L and SF-6D values. Models were validated using a 10-fold cross-validation method. Results: Considering the goodness of fit and predictive ability of models, the OLS Model 2 performed best for EQ-5D-5L (Adj R2 = 58.09%, Pred R2 = 58.93%, MAE = 0.0932, RMSE = 0.129) and the OLS Model 3 performed best for SF-6D (Adj R2 = 54.90%, Pred R2 = 55.62%, MAE = 0.0485, RMSE = 0.0634). Conclusion: Our results demonstrated that algorithms developed based on OLS Models 1 and 2 are the best for predicted EQ-5D-5L and SF-6D values, respectively.

This research is aimed to answer the fundamental question whether there is a significant relationship between return of discretionary reduction of general, sale, and administrative expenditures and reduction of the future performance. The question is presented as two hypotheses. Earnings management is measured using the benchmark for reducing of general, sale and administrative expenditures. The Statistical population of the research includes all firms listed in Tehran Stock Exchange. The sample consists of 114 listed firms during the period from 2011 to2016. Panel data analysis method, multivariate linear regression and Eviews9 software are used to test hypotheses and estimate coefficients. The results indicate that there is no significant relation between the return of discretionary reduction of general, sale and administrative expenses, and the reduction of future performance. But there is a significant relationship between the return of discretionary reduction in sales, general and administrative expenses, and the company limitation in earnings management of accruals

Objectives Many studies have mapped the QLQ-C30 onto the EQ-5D or the SF-6D utilities; however, these studies were limited to developed countries. So this study aimed to map QLQ-C30 onto the SF-6D version 2 (SF-6D-v2) and EQ-5D-5L using the data collected from patients with colorectal and breast cancer in a developing country. Methods A cross-sectional data set of 668 inpatient and outpatient patients with cancer was gathered from 4 teaching hospitals of cancer treatment in Tehran and Yazd from May 2017 to November 2018. The ordinary least squares (OLS) and censored least absolute deviations (CLAD) models were applied to estimate the utility values of both EQ-5D-5L and SF-6D-V2 using the QLQ-C30. Predicted R2 and adjusted R2 were used to evaluate the goodness of fit of the models. Moreover, the predictive performance of 2 models was assessed through estimating the mean absolute error (MAE), root mean square error (RMSE), intraclass correlation coefficients (ICC), and Spearman’s rho. The 10-fold cross-validation method was also applied for validation of models. Results The OLS Model E4 was the best-performing model for EQ-5D-5L (Adj R2 = 71.7%, Pred R2 = 71.15%, MAE = 0.0770, RMSE = 0.1026), and the OLS Model S4 performed best for SF-6D-V2 (Adj R2 = 74.64%, Pred R2 = 73.86%, MAE = 0.0465, RMSE = 0.0621). Conclusion The OLS Model E4 for EQ-5D-5L and the OLS Model S4 for SF-6D-V2 were the best models for policy makers to have more accurate evaluation of the healthcare interventions when the data are gathered through non-preference-based instruments.

Background: Ischemic heart disease is categorized into two acute and chronic groups, and its treatments include revascularization and medical therapy. The aim of this study is to evaluate the economic burden of medical therapy compared to percutaneous coronary intervention in ischemic heart disease. Methods: This study has been done in two steps. The first was a systematic review and meta-analysis to measure the effectiveness of two interventions and the second step was a cost-effectiveness analysis from the perspective of society. The data analysis included a meta-analysis and the Markov cohort simulation. RewMan v5 and tree age software were utilized. Uncertainties related to the model parameters were evaluated using one-way and two-way sensitivity analyses. Results: Regarding the effectiveness of interventions, the odd ratio of the quality of life in the medical therapy group (CI: 0.76-1.10) was 0.91 times the PCI group (p=0.34). This rate for mortality in medical therapy (CI: 0.52-9.68) was 2.23 times more than the PCI group; this result was not significant (p=0.02). In the cost-effectiveness analysis, the cost-effectiveness threshold was $ 16,482; ICER in increasing the QoL and reduction in the mortality rate was $ 25320.11 and $ 562.6691, respectively. Regarding the sensitivity analysis, the model was not sensitive in changing parameters in a specific domain. Conclusion: According to this study, PCI is more cost-effective than medical therapy in the reduction of mortality rate and in the field of increasing quality of life. MT strategy is more cost-effective than the PCI. This study considers controversies regarding the most appropriate treatment for patients with ischemic heart disease that is helpful for health policymakers, cardiologists and health managers.

Background: The EuroQol five-dimensional 5 level (EQ-5D-5L) value set is not currently available for the Iranian general public, while the value set for EuroQol five-dimensional 3 level (EQ-5D-3L) is available. The present study aimed to generate an interim EQ-5D-5L value set for the context of Iran. Methods: The Iranian interim EQ-5D-5L value set was generated using the crosswalk method, which maps EQ-5D-3L and EQ-5D-5L responses. The EQ-5D-3L value set has previously been estimated by Time Trade-Off (TTO) method. The interim value set obtained for EQ-5D-5L was compared with the value set of EQ-5D-3L by using measures of mean, median, and skewness.The analysis was done using STATA version 15. Results: The mean and median scores of the Iranian interim value set were 0.499 and 0.451 for EQ-5D-5L and 0.455 and 0.459 for Iranian EQ-5D-3L, respectively. The range of value for both EQ-5D-3L and interim EQ-5D-5L was -0.113 to 0.919. Data skewness of EQ-5D-3L and interim EQ-5D-5L was-0.099 and -0.114, respectively. In addition, the figure of distribution of value sets for both data sets had a tail extended towards the left. The states of "good health"(i.e., states with value>0.8) for the EQ-5D-3L value set were proportionally more than the Iranian interim EQ-5D-5Lcrosswalk value set (2.47% vs. 0.448%). Conclusion: An EQ-5D-5L value set was generated using the crosswalk method for the Iranian general public, and now researchers and policy-makers can apply it to their economic and clinical analyses.