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Abstract Background Medical diagnostic laboratories are an essential work environment that plays an important role in diagnosing, treating, and being sensitive to diseases. One way to evaluate laboratories’ performance is to calculate their efficiency. This study investigates the efficiency of laboratories that are related to health centers in the south of Iran. Methods This study was conducted in 2021. The input numbers include: the number of technical personnel and the number of cell counters, and the output data includes: the scores obtained from the level 2 health laboratory evaluation list. And efficiency was calculated with DEAP software. The analysis is accomplished by the assumption of input-oriented. Findings The efficiency of laboratories of Orzueeyeh and Ravar Cities had the highest efficiency with the assumption of variable returns to scale efficiency 1, and the model of all laboratories is the laboratory of Ravar City. The laboratories of Kuhbanan and Rabor cities had the lowest efficiency with the assumption of variable returns to scale efficiency of 0.859 and 0.899, respectively. The average scale efficiency, Variable returns to scale, and constant returns to scale for laboratories in the cities of Kerman province are 0.842, 0.943, and 0.895, respectively. Conclusions To increase the efficiency of laboratories, significant resources and funds should be used, as well as few studies have been done on the efficiency of laboratories, which requires more attention.

IntroductionHIV drug resistance (HIVDR) is an important challenge in the fight against HIV/AIDS and can threaten progress toward achieving the target of HIV elimination by 2030. Genotyping pretreatment HIVDR testing (DRT) has been proposed as a potential solution. However, the cost-effectiveness of this intervention needs to be evaluated to determine its feasibility and potential impact on healthcare systems. This study aimed to assess the cost-effectiveness of DRT among people living with HIV (PLHIV) in Iran.Methods1000 hypothetical PLHIV were simulated in terms of cost and effectiveness based on quality-adjusted life Years (QALY). The Markov Model was developed to calculate incremental cost-effectiveness ratio (ICER) using TreeAge Pro 2020. Deterministic and probabilistic analyses were performed for sensitivity analyses.ResultsResults showed that compared to not performing pretreatment HIVDR testing, this intervention gained 0.035999 QALY with an incremental cost of 1,695.32 USD. The ICER was calculated as 47,093.53 USD, indicating that pretreatment DRT was not cost-effective. The probability of opportunistic infection (OI) in people with viral failure, the effectiveness of Dolutegravir in people without drug resistance, and the quality of life (QoL) of people in the AIDS stage were found to be the most important variables affecting ICER. With an increasing willingness to pay more than 53,000 USD, pretreatment DRT testing will become cost-effective.ConclusionBased on our findings, pretreatment HIVDR testing is not currently cost-effective in Iran as it imposes high costs on healthcare systems with few benefits for People living with HIV (PLHIV). However, if resources are available, drug resistance testing can be a valuable tool in generating HIV molecular data and molecular surveillance of HIV.

Abstract Background Cost-effectiveness analysis plays a key role in evaluating health systems and services. Coronary artery disease is one of the primary health concerns worldwide. This study sought to compare the cost-effectiveness of Coronary Arteries Bypass Grafting (CABG) and Percutaneous Coronary Intervention (PCI) through drug stent using Quality-Adjusted Life Years (QALY) index. Methods This is a cohort study involving all patients undergoing CABG and PCI through drug stent in south of Iran. A total of 410 patients were randomly selected to be included in the study. Data were gathered using SF-36, SAQ and a form for cost data from the patients' perspective. The data were analyzed descriptively and inferentially. Considering the analysis of cost-effectiveness, Markov Model was initially developed using TreeAge Pro 2020. Both deterministic and probabilistic sensitivity analyses were performed. Results Compared with the group treated with PCI, the total cost of interventions was higher in the CABG group ($102,103.8 vs $71,401.22) and the cost of lost productivity ($20,228.68 vs $7632.11), while the cost of hospitalization was lower in CABG ($67,567.1 vs $49,660.97). The cost of hotel stay and travel ($6967.82 vs $2520.12) and the cost of medication ($7340.18 vs $11,588.01) was lower in CABG. From the patients' perspective and SAQ instrument, CABG was cost-saving, with a reduction of $16,581 for every increase in effectiveness. Based on patients’ perspective and SF-36 instrument, CABG was cost-saving, with a reduction of $34,543 for every increase in effectiveness. Conclusion In the same indications, CABG intervention leads to more resource savings.

Background: Visceral leishmaniasis (VL) is a neglected infection currently occurring in some regions of Europe, Asia, Africa, and America. This study was an attempt to determine the temporal patterns of VL from January 2000 to December 2019 in the Ardabil Province of north-western Iran using the Markov Switching Models (MSM).Methods: This descriptive study used monthly data of 602 VL cases during the study period. The data were provided by the Leishmaniasis National Surveillance System (LNSS), the Iran Meteorological Organization (IMO), and Space Agency (SA), and two states were considered for such modelling. Given the Akaike and Bayesian information criterion, the two-state MSM with a five-month lag is an appropriate model.Results: The MSM showed that the probability of staying in the non-epidemic state is 67%, (P11), while that of staying in an epidemic state is 93% (P22). The mean absolute percentage error (MAPE) was 31.63%, and the portmanteau test (Q=19.03, P=0.66) for the residuals of the selected model revealed that the data were completely modelled. The total VL cases in the next 24 months forecasted 14 cases.Conclusion: The MSM has a relatively acceptable predictive power and is useful in planning future interventions with more information about different stages of the epidemic it provides to policymakers for early warning of epidemics.

Background: Cerebral palsy is a movement disorder syndrome in early childhood. Signs and symptoms vary among people and over time but include poor coordination, stiff muscles, and weak muscles. Some affected children can achieve near-normal adult lives with appropriate treatment. In recent years, transplantation of human mesenchymal stem cells (hMSC) has become a promising therapeutic strategy for CP. Every year, a lot of costs are spent on the treatment and management of this disease. The purpose of this study is to investigate the safety and effectiveness of this method on CP. Methods: This article is a systematic review. At first, a search strategy was written and performed in Scopus, PubMed, and Google Scholar databases(The search was conducted from March 14 to March 28, 2021), and the inclusion and exclusion criteria were determined. Study inclusion criteria: review studies, cohort studies, clinical trial studies (randomized and non-randomized), control case, and retrospective , exclusion criteria: non-English articles and studying on animals. After removing duplicate articles, two authors independently reviewed the studies according to the inclusion and exclusion criteria. Disagreements among the authors were resolved through discussion. Findings: In total, 9236 articles were found in the initial search, after reading the titles, of 37 articles, 21 articles were selected in the abstract stage and 18 articles remained in the full-text stage. We finally found 18 articles that showed that using stem cell technology as a scientific method could improve sick patients’ quality of life and movement defects. Conclusion: According to the available evidence and limited studies, stem cell technology can be safeand cost-effective in improving CP patients, but there is insufficient evidence. On the other hand, there are many studies confirming the effectiveness of these cells in the treatment of movement impairment. In conclusion, stem cells may have a very promising future. Finally, stem cell technology combined with innovative biotechnologies may soon bring promising results to patients.

Background: Hospitals are the most important executive part of healthcare systems. During COVID-19 crisis, they faced a sudden demand, and spent the hospital resources and equipment in order to provide treatment services to COVID-19 patients. Considering that the provision of services was focused on these patients, the efficiency of hospitals during this crisis was not clear. The purpose of the current research is to investigate the efficiency of hospitals affiliated with Kohgiluyeh and Boyer Ahmad University of medical sciences, as well as the imaging units as the most important diagnostic department in the time of this pandemic. Methods: This was a quantitative and retrospective study which examining technical efficiency of 6 hospitals affiliated with Kohgiluyeh and Boyer Ahmad University of medical sciences. In addition, the technical efficiency of the imaging units (CT scan, radiology and ultrasound) in these hospitals was evaluated. Technical efficiency was calculated and compared through different scenarios based on different inputs and outputs during the pandemic. The model used in this research was multi-stage DEA. To analyze the data, the output maximization model and variable returns to scale were used. Relevant data were collected for a one-year period, from October 2020 to October 2021. Technical efficiency was calculated using Deap 2.1. Results: The average technical efficiency of the hospitals affiliated with Kohgiluyeh and Boyer Ahmad University of medical sciences during COVID-19 pandemic was 0.80 which was satisfactory. The average efficiency of CT scan, ultrasound and radiology units in the studied hospitals and based on the defined scenarios was 0.67, 0.44 and 0.40, respectively. This shows that the ultrasound and radiology units are far from efficient. Conclusion: The hospitals under study as well as CT scan units were efficient during COVID-19 crisis. Examining the efficiency of the returns compared to the scale showed that increasing the number of beds as well as the equipment would not increase efficiency. Paying attention to the needs of population under study and financing them accordingly, would lead to the financial efficiency of the hospitals.

Background and Aim: Hospital is organization which its performance improvement is very important. In order to do this, we must evaluate the allocated resources and performance of hospitals. Calculating hospitals efficiency is one of the possible ways to evaluate the performance of them. In this study, the efficiency of allocated financial and human resources of public hospitals by provinces is examined. Materials and Methods: This study was conducted in 2017-2018. Data were collected from 31 provinces of Iran. Input (including: number of physicians, number of nurses and number of active beds per ten thousand population) and output (number of hospitalizations and number of outpatients per ten thousand people). Data were collected from studies. The efficiency analyzing of the provincial treatment department was performed with DEAP software. Results: The input population (nurse, doctor, bed) is related to hospitals and health centers in Semnan, Yazd and Mazandaran provinces And the least amount of input was related to Sistan and Baluchestan, Khuzestan, North Khorasan provinces. The highest output (inpatient and outpatient) belongs to East Azarbaijan province and the lowest output belonged to Hamedan province. Efficiency score, variable return to scale and constant return to scale for all hospitals in the country are 0.565, 0.813 and 0.47, respectively. Conclusion: proper and correct distribution of resources between provinces may increase efficiency of resource distribution.

Objective: To investigate the quality of life (QOL) of injured motorcyclists and associated factors in a period of three months after the accident. Methods: In the present study, we were included 190 injured motorcyclists who admitted to two referral specialized hospitals (Emam Reza and Shohada) in Tabriz, between June 2018 and January 2019. All injured motorcyclists were contacted through the telephone one and 171 of them (90%) three months after their accident to complete an EQ-5D-3L questionnaire. The baseline measurements were gathered by using face to face interviews in the hospitals. The QOL score could vary between 1 and 3. The higher score showed a lower QOL. Results: The injured motorcyclist’s QOL score was relatively better in three months after the accident (mean±Standard Deviation (SD): 1.78±0.51) in comparison with their status a month after the accident (2.15±0.65) (p

Vaccination is an essential way to prevent the transmission of hepatitis B virus (HBV). Various studies have been published on the cost-effectiveness of HBV vaccination, but since the results vary according to the target population and related health outcomes, this study examined the cost-effectiveness of the universal HBV vaccination in Iran. In this economic evaluation study, a decision tree with the Markov model was used to compare the universal HBV vaccination with a strategy of non-vaccination. Health states used in the model included healthy, chronic hepatitis B, compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and death. Analyses were performed from a payer’s perspective. Incremental cost-effectiveness ratio (ICER) per life-year gained, and quality-adjusted life-years (QALYs) gained were calculated at a 5% annual discount rate. The sensitivity analysis was conducted using Monte Carlo simulation. Analyses were performed using Microsoft Excel and TreeAge Pro 2011 software. In 2017, the estimated cost per dose for any HBV vaccine was $3.20 USD. The universal HBV vaccination was economically advantageous compared to non-vaccination, and the estimated cost of this program per life-year and QALY gained were $6,319 and negative (-) $1,183.85 USD, respectively. Given the uncertainty of all parameters, the model remained robust and reliable. In Iran, the universal HBV vaccination strategy for both health outcomes of QALY and life-years gained was cost-effective and advantageous. The vaccination strategy saved money, increased life years and improved quality of life. Therefore, it is recommended that this program continues to be provided.

Background: Initiatives to improve the quality of health services and reduce costs currently have centered around payment mechanisms. In Iran, like many other countries, the outpatient visit costs are paid via fee for service, while real-time visits and other details of provided services are not considered in the tariff setting process. This study attempted to calculate the visit costs of various service provider groups and compared them with tariffs. Methods: In this cross-sectional research, the essential data about different costs were collected from providerschr('39') offices, standard time of each visit was achieved from Iranchr('39')s Ministry of Health and Medical Education, current visit time of service providers was calculated based on health insurance companieschr('39') data across the country. After calculating the standard and current visit costs through the activity-based costing technique, main determinants of costs (major cost centers) were specified for use in probably future weighted tariffs in fee for service payment mechanism. Results: The greatest difference between standard and the current number of visits was found in the Sub-specialist physician group (6784 in a year), and the greatest difference was between standard and current cost of visits in sub-specialist psychiatrists (126703 IRR). Staffing and rental cost centers account for the highest share of total visit cost (87 %). Conclusion: This study demonstrated a significant difference between the current and standard visit costs with tariffs. Therefore, it is essential that policymakers improve the payment mechanism by modifying the visit tariffs for medical service providers. One suggestion in this way is using domestic relative value units according to costing research results.

Objective: To determine the potential effect of environment variables on cutaneous leishmaniasis occurrence using time-series models and compare the predictive ability of seasonal autoregressive integrated moving average (SARIMA) models and Markov switching model (MSM). Methods: This descriptive study employed yearly and monthly data of 49 364 parasitologically-confirmed cases of cutaneous leishmaniasis in Isfahan province, located in the center of Iran from January 2000 to December 2019. The data were provided by the leishmaniasis national surveillance system, the meteorological organization of Isfahan province, and Iranian Space Agency for vegetation information. The SARIMA and MSM models were implemented to examine the environmental factors of cutaneous leishmaniasis epidemics. Results: The minimum relative humidity, maximum relative humidity, minimum wind speed, and maximum wind speed were significantly associated with cutaneous leishmaniasis epidemics in different lags (P

Background: Acute leukemia is a kind of aggressive disease that includes high rates of fatalities in the world, in particular in Iran. This research was done to determine the survival rate of patients with acute leukemia in Iran. Methods: 85 adult patients who were first diagnosed with acute leukemia in Shahid Bahonar hospital of Kerman during March 2012 until March 2013 were evaluated in a retrospective descriptive study to measure the death/life status in a 5-year period (2012-2017). The required data was gathered from medical records of patients, HIS system data, and the cancer registry system, and the Kaplan-Meier estimator and Log Rank test were used to calculate the survival rate using SPSS23. Results: Survival rate was completely 45.9 % for patients with acute adult leukemia. It was 47.08 % in acute myelogenous leukemia (AML) and it was 43.06 % in acute lymphocytic leukemia (ALL). The 1,2,3,4 and 5-year survival of acute leukemia was respectively 87.1 %, 69.4 %, 62.4 %, 56.5 % and 45.9 %. Conclusion: Iranchr('39')s health system should design and plan to increase the survival of patients with acute leukemia by improving the methods and facilities to diagnose and treat it more quickly and more effectively.

Background: The implementation of different reimbursement methods has various positive and negative effects on the health system of different countries. Identifying the challenges of these methods is essential to improve these reimbursement methods and modify them if required. This article aimed to qualitatively assess the challenges of current hospitals' payment systems in the Iranian health system and determine the required solutions for modifying these payment systems. Methods: This qualitative study was conducted in 2019. Semi-structured interviews were conducted recruiting 20 experts including operational, middle and top managers working in three different levels of health systems. Data collection was continued until it reached a saturation point. MAXQDA 10 was used for data analysis. The data content analysis method was used to analyze the data and the themes and categories were determined. Results: The challenges of the payment systems were categorized into four main themes regarding policy, cost, regulatory and functional challenges, and 15 sub-themes. The findings related to the proposed strategies were presented in six main themes consisting of legal solutions, structural reform, cost, quality improvement, service provider and client, and monitoring and evaluation; and 12 sub-themes. Conclusion: This study showed that the health systems in Iran face various structural and procedural challenges in terms of reimbursement mechanisms. Therefore, it is recommended that policymakers pay attention to these challenges before making any changes. Using hybrid payment systems can be one of the proper solutions.

Context: skin and wound health a serious public health problem with high morbidity and mortality rates worldwide. Although there are different treatment options presented, there is no agreement on the best treatment for severe burns and wound problems as of yet. Stem cell therapy has a bright prospect in many preclinical studies of burn wounds. The rapid review was performed to assess the efficacy and possible mechanisms of stem cells in wound healing. Methods: This is a rapid review of the evidence for the potential effects of stem cell on wound healing, which intended to create a policy guide. To do so, health technology assessment studies indexed in PubMed, Scopus and Scholar on March 13, 2021 were searched using the keywords, including stem cell effects and wound healing. In addition, references of recovered studies were checked to ensure through the capture of the literature. Studies on the safety and efficacy of stem cell on wound healing, both in Persian or English, were included. Results: In total 92 titles were identified, which after eliminating duplicates and applying inclusion criteria, 22 were included. The overall review showed that stem cell therapy improved wound but more study is needed though it is promising. Also, studies showed using stem cell technology as a non-invasive way can be a good alternative to older treatments. Finally, Restrictions of this technology may include the need to improve cell delivery methods, cell viability, heterogeneity in the preparation of mesenchymal stem cells, and wound substrate. Further studies may be needed to determine its safety and efficiency. Conclusions: Evidence on the safety and efficacy of stem cell on wound were very limited to make a decision but Studies showed that stem cell technology is a good alternative to traditional therapies. These findings also demonstrate the need for considering variations in future clinical studies using stem cells to treat a burn wound in order to maximize the effectiveness.

Background: Considering the increasing growth in health care costs along with the resources finitude; therefore, improving the efficiency and efficient use of resources is considered as one of the main priorities of the health system. The aim of this study was to determine the efficiency of direct medical services affiliated with Iranian Social Security Organization using Stochastic Frontier Analysis (SFA) Method in 2008-2015. Materials & Methods: In this descriptive- analytical study, performance of 30 units of direct medical services affiliated with Iranian Social Security Organization was analyzed using Stochastic Frontier Analysis (SFA) Method. The number of active beds, physicians, nurses and staff were used as inputs and combined variables obtained from factor analysis were selected as output. Frontier version 4.1 was used to determine the efficiency and Stata version 14 was used to study the effective factors on efficiency. Results: The average technical efficiency of studied units was 0.816. Based on the value of index of likelihood ratio test ( LR = 100.45 ), Cobb-Douglas production function was selected as the best model. Conclusion: Based on the findings of this study, adjusting surplus manpower, congenital planning for increasing efficiency and resource management should be the priority of the managers so that they can increase the level of efficiency of studied units and reduce the costs to the least possible.

Assisted reproductive technologies (ARTs) are often considered luxury services by policy-makers and the general population, which are always susceptible of removal from public funding of health care. The analysis of the economic aspects of this scope seems essential due to the high prevalence of infertility in Iran and the high costs of infertility treatments. This study aimed to investigate the value put on IUI and IVF treatments by communities in Iran and the affordability of services based on community preferences. A cost-benefit analysis (CBA) was performed based on the WTP approach, and the contingent valuation method (CVM) was used to estimate WTP for IUI and IVF using a researcher-made survey in two cities of Kerman and Isfahan, Iran, in 2016-17. The sample size was 604, and the study sample frame to estimate WTP included two groups of couples who were/were not aware of their fertility statuses. The costs of one cycle of IUI and IVF were calculated according to the treatment protocols, tariffs of 2016-17, and medical information records of patients. The mean direct and indirect medical costs of one cycle of IUI and IVF were equivalent to 19561140 and 60897610 IRR, respectively. Also, the mean WTP for IUI and IVF treatments were obtained of 15941061 and 28870833 IRR, respectively. The demand for IUI and IVF treatments was elastic and the community was sensitive to price changes of these treatment methods. IUI and IVF treatments brought no positive net benefits, and economic variables had the highest impact on the WTP and community preferences, indicating the significant role of financial constraints in the community's valuation for advanced infertility treatments in Iran.

Background and Aim: One of the common problems of children all over the world is short stature. Due to the high costs of treatment, the present research studied the cost-effectiveness of growth hormone (Somatropin) for the treatment of children with short stature in Kerman Province. Materials and Methods: This research is an economic evaluation. The population of the study consisted of all persons who had medical records in the health insurance office of Kerman province, of whom 49 were selected as samples. The cost was calculated from the perspectives of patients and insurers. This information was collected through a researcher-made form by interviewing the patients and reviewing the records of health insurance office. To calculate the outcomes, QALY and Increase in Height were used. For cost effectiveness analysis, the ICER formula and TreeAge software were employed and compared with a threshold of 3 times GDP per capita. Results: The findings showed that the share of patientschr('39') treatment costs was 5,092,964,520 and the expenses of Health Insurance Organization of Kerman province was 71,175,443,448 rials. Based on Qaly criterion, incremental cost-effectiveness ratio was 743,133 and 9,846,567 rials from the perspective of the patient and of the health insurance organization, respectively. Sensitivity analysis of non-deterministic parameters of the model showed that they had no effect on the cost-effectiveness of treatment with growth hormone. Conclusion: According to the results, the treatment of short-stature children with growth hormone is cost-effective, and this result can be considered by health system policy makers.

Introdution: Due to the high prevalence of infertility in Iran and the high costs of infertility treatments, analysis the economic issues of this scope seems important. The aim of this study was to present the scientific evidence of the community valuation for infertility pharmaceutical treatments and precise costing of these treatments using economic analysis. Methods: This study was a cross-sectional study of cost-benefit one of the economic evaluation of the health interventions studies. The per capita cost of one cycle of infertility pharmaceutical treatments was calculated based on the treatment protocols and prescriptions of physicians. Measuring the willingness to pay people was done using a contingent valuation method (CVM) using a researcher-made questionnaire in Kerman. Results: Per capita cost per cycle of infertility pharmaceutical treatments was estimated at 6689640 Rls. The willingness to pay for these treatments was also 13198125 Rls per treatment cycle. Based on the cost and outcome, the calculated net present value (NPV) and the benefit cost ratio (BCR) were 6508485 Rls and 1.97, respectively. Conclusion: According to the results of the study, the valuation of individuals for infertility pharmaceutical treatments is about twice the cost of one cycle of these treatments, which suggests that investment for this level of treatments has a positive net benefit. Therefore, it is required that policy-makers pay more attention to the issue of scientific financing of infertility in the current period that we require population growth in Iran.

Background: Cigarette seems to be the least valuable of addictive drugs. It is easily accessible to the public, and its harmful personal and social effects have attracted less attention. Therefore, the present research was carried out with the aim of presenting cost estimations of smoking-related diseases in smokers who aged 35 or higher in Kerman City, Iran, in 2014.Methods: Using the prevalence approach, the direct and indirect costs of smoking-attributable diseases including lung cancer, gastric cancer, myocardial infarction, stroke, and chronic obstructive pulmonary disease (COPD) were estimated. The initial data were obtained from the information in documents of medical document units as well as the 2014 income statements of teaching hospitals of Kerman University of Medical Sciences, Kerman City.Findings: In this research, total economic costs of diseases attributed to smoking were estimated to be 50 million dollars in 2014 in Kerman City, and calculations suggest that this figure accounts for 0.02% of Iran’s gross domestic product (GDP). Total direct cost of diseases caused by smoking in Kerman City adds up to 17 million dollars, whereas the estimated indirect cost of diseases caused by smoking is 33 million dollars. The yearly per capita cost of any of the selected five diseases is 270 dollars.Conclusion: Smoking places a high economic burden on health system and society as a whole. Therefore, stronger intervention measures against smoking should be taken without delay to reduce the health and financial losses caused by smoking.

Introduction: Achievement of economic growth, as one of the most important macroeconomic variables, depends on the precise understanding of potential routes and the factors affecting on it. The aim of this study was to evaluate the health care sector’s effect on Iran Gross Domestic Product (GDP), as the status of economy. Method: Artificial Neural Network (ANN) and Dynamic Ordinary Least Squares (DOLS) were performed according to Iran GDP as the output variable and the input variables of life expectancy at birth, under five mortality rates, public health expenditures, the number of doctors and hospital beds during 1961-2012 in Iran. Data were collected from the Statistical Center of Iran, the Central Bank of the Islamic Republic of Iran, the World Health Organization and the World Bank databases. Data management and analysis were performed using Eviewes 7, stata 11 and also Mathlab. MSE, MAE and R2 were calculated to assess and compare the models. Results: One percent reduction in deaths of children under 5-years could improve Iran GDP as much as 1.9%. Additionally, one percent increment in the number of doctors, hospital beds or health expenditure would increase GDP by 0.37%, 0.27% and 0.29%, respectively. Mean Absolute Error (MAE) demonstrated the superiority of DOLS in the model estimation. Conclusion: The lack of sufficient considerations and excellent models in the health care sector is the main reason for underestimating the effect of this sector on economy. This limitation leads to neglecting the resource allocation to the health care sector, as the great potential motivation of the economic growth.

Background and Aim: Hospital as an economic entity, should utilize economic analysis for the optimal use of resources and production facilities. The aim of this study was to estimate the production function of Ahvaz University of Medical Sciences during the period 2006-2014. Materials and Methods: This study was a descriptive cross-sectional analysis. The Data were collected during a period of 9 years in 7 hospitals in Ahvaz. The dependent variable in this study was the number of hospital admissions as the production level and the explanatory variables, including nurses, physicians, staffs, and the number of beds. To determine and specify the form of subordinated Cobb - Douglas production function was used. Data analysis and econometric model was estimated using STATA11. Results: Research findings showed 0.28 elasticity for the physicians, elasticity for nurses, number of beds , outpatient reception and other staffs were 0.10, 0.95, 0.30 and -0.11 respectively. In other words, the most production in these hospitals was dependent on the number of beds. It was an economic activity that consumed a lot of capital. The sum of the coefficients of the production function was 0.88 and the return to the scale was downward. Conclusion: The findings of this study showed that hospital beds have great importance in increasing production. Therefore, the rate of active bed occupancy in these hospitals is high and has the largest role in the production of hospitals or the number of inpatient discharge.

BACKGROUND AND AIM: Oral diseases are very important because they impose economic and social burden on societies. Given the resource scarcity, it is necessary to devise cost-effective and scientific strategies to prevent and control oral diseases. This study aimed to estimate the potential cost-savings for dental caries treatment associated with Community Water Fluoridation Program (CWFP) in Kerman, Iran. METHODS: An economic model to compare the costs of CWFP with treatment savings achieved through averted tooth decay was developed. Direct cost of prevented caries was taken equal to treatment savings. Implementation cost and the associated savings was estimated for Kerman in 2016. We obtained required data and parameters for costs and savings estimation through published documents and other sources. RESULTS: Annual cost-savings associated with implementing the water fluoridation in Kerman was estimated about $11160415.5 to $44350544.11. About $34.9 to $136 could be achieved per each dollar spent. Annual cost and benefit per capita was $0.66 and $23.4-$91.09 respectively. Net benefit per capita was $22.7 to $90.4. CONCLUSION: This study indicates significant annual savings from CWFP; additional savings could be achieved if this program is implemented in other regions. We could also receive even more if this program is integrated with other public oral health programs such as screening school children, community dentistry and oral health education.

Background: It is believed that laboratory tariffs in Iran don’t reflect the real costs. This might expose private laboratories at financial hardship. Activity Based Costing is widely used as a cost measurement instrument to more closely approximate the true cost of operations. Objective: This study aimed to determine the real price of different clinical tests of a selected private clinical laboratory. Methods: This study was a cross sectional study carried out in 2015. The study setting was the private laboratories in the city of Kerman, Iran. Of 629 tests in the tariff book of the laboratory (relative value), 188 tests were conducted in the laboratory that used Activity Based Costing (ABC) methodology to estimate cost-price. Analyzing and cost-price estimating of laboratory services were performed by MY ABCM software Version 5.0. Results: In 2015, the total costs were $641,645. Direct and indirect costs were 78.3% and 21.7% respectively. Laboratory consumable costs by 37% and personnel costs by 36.3% had the largest share of the costing. Also, group of hormone tests cost the most $147,741 (23.03%), and other tests group cost the least $3,611 (0.56%). Also after calculating the cost of laboratory services, a comparison was made between the calculated price and the private sector’s tariffs in 2015. Conclusion: This study showed that there was a difference between costs and tariffs in the private laboratory. One way to overcome this problem is to increase the number of laboratory tests with regard to capacity of the laboratories.

Objective (s): Performance and efficiency evaluation always is a process that analyzes the healthcare organizations. Hospitals in order to provide medical services and to fulfill their mission also require this type of evaluation. This paper aimed to review the efficiency studies of the hospitals in Iran. Methods: We attempt to evaluate the efficiency of hospitals using keywords such as hospital efficiency, performance evaluation, data envelopment analysis, stochastic frontier analysis. In all 1150 articles were identified. Of these 52 articles assessed the performance of hospitals and 18 articles investigated the efficiency. These papers evaluated 262 hospitals affiliated to medical universities nationwide. Results: This systematic review showed that the highest efficiency was related to the hospitals in Tabriz University of Medical Sciences during 2005-2008 and the lowest performance was determined for the West Azerbaijan province in 2009. Also, the highest efficiency of the management of the hospitals was related to the Kerman University of Medical Sciences in 1386 and the highest scale efficiency was related to Hamadan of Medical Sciences in 2010. Conclusion: Since there were a number of inefficient hospitals, it is necessary for policy makers to adopt solutions for efficiency promotion and appropriate distribution of resources. Additionally, it is recommended that the officials design an specific databases to evaluate efficiency regularly.

Background: One way to improve the performance of hospitals, the largest resource-consuming units in the healthcare sector, is to continuously evaluate their performance.Objective: The current study assessed the performance of hospitals affiliated with the Kurdistan University of Medical Sciences using data envelopment analysis (DEA).Methods: This retrospective descriptive-analytic study used DEA to assess efficiency types (technical, managerial, and scale) in hospitals of the Kurdistan University of Medical Sciences (n = 12) in the years 2007 to 2011. The number of active beds, nurses, physicians (general and specialist), and other staff were inputs; inpatient admission and occupied bed days were outputs. Stata version 12 was used for data analysis.Results: The mean technical, scale, and managerial efficiency values were 0.85, 0.89, and 0.95, respectively. The highest and lowest slack inputs were nurses and active beds, respectively.Conclusion: The findings indicate that Kurdistan hospitals were less than appropriately efficient during the studied period. They also suggest that there is a capacity of about 15% for enhancing output in hospitals (compared with the most efficient studied hospitals) without increasing costs or inputs.

Background: Chronic renal failure disease is considered as a health problem . Because of their high prevalence and economic burden on the society, health system managers consider to the disease as a public health concern. This study aimed at comparing the cost-effectiveness of long-term dialysis treatments and kidney transplant using DALY index. Materials and Methods:This cross-sectional study was designed to compare the cost-effectiveness of two methods such as long-term hemodialysis and kidney transplant using Disability Adjusted Life Years (DALY) in Afzalipour Hospital of Kerman in 2012. The decision tree model and TreeAge software were used for data analysis. In this research, costs and effects were studied from the patient perspective. Results: The cost of a kidney transplant was 165 million Rials, effectiveness of a kidney transplant was 4.40 DALY, chronic dialysis cost was 1.283 billion Rials and its effectiveness was 6.52 DALY. Cost-effectiveness ratio for dialysis was 196 million Rials per DALY and this ratio is 37 million Rials per DALY for a kidney transplant respectively. According to the findings, kidney transplant is more cost effective than dialysis. Conclusion: This study suggests kidney transplant over dialysis due to its better quality of life and more life expectancy. The results can help out the government to decide about the more resource allocation to kidney transplant programs. The method in this research can be applied to measure the cost-effectiveness of other organs transplantation.

Abstract Introduction: knowledge and understanding of the situation is necessary for planning to achieve optimal development that this identifying involves separating study regions to planning areas and evaluation of the separate regions by development indicators and analysis and ranking of each area in terms of having development blessings. This study aims to Stratification of Kerman Province Districts in Terms of Health Indicators with taxonomy models. Materials & Methods: This descriptive study was applied using taxonomy Models to Stratification of 16 Kerman Province Districts based on 10 selected health indicators. Data were collected by the researcher form and through statistical center of Iran and Kerman University of Medical Sciences. Data analysis was done using SPSS/19. Results: The calculations based on taxonomy Model, Baft district with 0.46 and Rigan district with 0.96 were most and less developed districts, respectively. Conclusions: there is a relatively large difference between cities in the health sector and Most of the citiesare not satisfactory in the aspect of healthcare indices. So having plan on how to allocate resources for the health sector to improve the health of the cities is essential for policy makers.

Background: Laboratory services fragmentation creates problems such as non-accountability for costs and quality, not being patient-centered and unsustainability of services in long run. Therefore, health systems consider laboratory services integration an inevitable way. This study aimed to investigate the challenges and barriers to the integration of laboratory services in Iran. Methods: This qualitative case study was conducted in 2016. Using purposive sampling, semi-structured interviews were conducted with 34 informed participants. Each interview lasted between 30 to 60 min. Acceptability, transferability, reliability, and verifiability were used to assess the validity, accuracy and reliability of qualitative data. Framework approach was used to analyze data. Results: Lack of economy of scale, unfair access, lack of grading, low quality, development of national strategies to create an integrated network of laboratories, criteria of the laboratories establishment, creation of necessary infrastructure, empowering the private sector and standardization of indicators were considered the most important problems of laboratory services integration in Iran; they were classified into two main themes. Conclusion: Identified issues are challenges which adversely impact the integration of laboratory services. Therefore, providing infrastructures with increased cooperation between various organizations to increase access to laboratory services in the form of an integrated network is essential.

Introduction: Cost is becoming a growing concern for the managers of health and treatment institutes both in private and public sectors. Based on the opinions of pathology and radiology specialists and experts, one private and one public center for radiology and laboratory were selected to study in Kerman City. Method: This is a cross-sectional and applied study. The two centers were similar in frequency of their services, different tests they were conducting, and their number of personnel. Afterwards, the costs of services in both fields were determined using the activity-based costing method. This study was carried out from March 21 to September 22, 2014. The costs of services in both private and public sectors were compared to the tariffs of the Ministry of Health in 2014. Results: Laboratory results indicated that the costs in all the selected tests were higher than the tariffs and the largest difference (app. 84,930 Rls) was observed in the TSH test while the smallest difference was observed in the ferritin test (11,940 Rls). However in the private sector, vitamin D and FBS tests were not profitable with differences of about 5500 and 6500 Rls, respectively. In other tests, the costs in the private sector were lower than the tariffs for the private sector. In the private sector radiology center, only the MRI services were not profitable but the other services were. The cost of MRI services in the private sector studied in this research was 190,000 Rls higher than the private sector tariffs. Conclusion: In this study, the results showed that CT scan services were the most profitable services and the price difference was about 203,000 Rls per service. However, all of the radiology services were unprofitable in the public sector and the largest price difference was seen in MRI services which was about 590,000 Rls per service.

Background: During the last decades, the number of dentistry units increased significantly across the country. The aim of this study was to assess the efficiency of dental units of Iran provinces regarding dental health inputs and outputs using Data Envelopment Analysis approach. Methods: In this applied descriptive-analytical study, the study population included all of Iran 31 provinces. The output variables included DMFT and DMFT indices of 6-12 yr old students. The data about DMFT and DMFT indices were taken from 2013 Nationwide School Pupils Screening Program. Input variables included active dental chairs located in the public sector, general dentists of public sector, general and specialist dentists of private sector by different provinces. The data were analyzed using Deap software version 2.1. Results: The lowest amount of scale efficiency was for Tehran Province (0.204) followed by Isfahan Province (0.205). Provinces of Isfahan, Razavi Khorasan, Kerman, Zanjan, Hamedan, Kordestan, Golestan, Yazd and Tehran, Iran had decreasing return to scale and provinces of Gilan, West Azerbaijan, Mazandaran, Fars, Kermanshah, Markazi, Lorestan, Qazvin, Sistan-and-Baluchestan, Bushehr, Alborz, Hormozgan and Khuzestan had increasing return to scale. Conclusion: Despite provinces of Isfahan, Razavi Khorasan, Kerman, Zanjan, Hamedan, Kordestan, Golestan, Yazd and Tehran which had a better situation in terms of the number of dentistry chairs, public dentists, general and specialist dentists of private sector than other provinces, they had decreasing return to scale. Investment in dental primary health care, preventive and educational programs can be more cost-effective.

Introduction: Quality improvement is one of the important challenges of health systems. Baldrige excellence model, which makes use of self-assessment mechanisms to promote organizations, has optimized the principles of Total Quality Management (TQM) to improve the quality in teaching and treatment organizations. The aim of the present study was to evaluate the clinical and educational system of the teaching hospital based on Baldrige Excellence Model.Materials and Methods: This study was a descriptive-analytical, cross-sectional survey conducted in the Baqiyatallah hospital in Tehran in 2011. The data were collected based on Baldrige questionnaire (version2009-2010) through interviewing the educational managers and the staff, studying the recorded documents and observing the processes. The scores were calculated based on Baldrige Vote matrix, and Excel 2007 software was used to analyze the data.Results: The selected hospital obtained 332.94 (33.2%) points out of 1000 in the Baldrige modeling clinical-educational section. Organizational leadership criterion with 53.95 out of 120 points (44.96%) and performance results criterion with 109 out of 450 points (24.44%) were the strongest and weakest in this hospital, respectively.Conclusion: Despite the fact that, due to the implementation of WFME, this center has an appropriate approach for excellence, it is in need of further improvement at the levels of learning and organizational integration. We recommend the use of advanced sections capabilities for organizational integration and the reinforcement of current accreditation system based on Baldrige Model criteria.

Introduction: Efficiency evaluation is a fundamental necessity with respect to confronting and facing evolutions in order to improve activities. Considering that one of the main indices for assessing the development of a country is currently its share in producing knowledge, evaluating the performance of educational units and their efficiency is necessary. We aimed to study the efficiency of health information technology departments of medical universities using the data envelopment analysis (DEA) method.Materials & Methods: In this descriptive-analytical study we used the mathematical model of DEA using the Deap2.1 software for evaluating the efficiency of health information technology departments of Iranian medical universities during 2011. To gather data, a researcher-made form was designed including information on the number of students, faculty members, number of written books and translations by faculty members, research papers, etc.Results: The results showed that of 18 educational departments, 6 departments were efficient and 12 departments were inefficient. Optimal and ideal values were determined for ineffective groups in order to achieve efficiency.Conclusion: To achieve maximum efficiency (=1), departments should increase their research output through more research projects, articles or books. These departments should establish a long-term program to reduce training inputs (students) and its funds based on the specified surplus amount.

Introduction: Because of the close relationship between economic growth and well-being, many economists have sought to identify the sources of economic growth. Human capital, through increased quality, increased wages will enhance economic growth .Today, Development Economists studies shows government policy such as Investing in human capital and R&D expenditure affected on Income distribution and reduction of inequality in countries economics.Materials and Methods: This study is based on data of 2011 Iranian social accounting matrix using structural path analysis. The study population was included all the economic sectors and households in Iran. Sim sip -SAM software used for analysis of data.Results: With increase of 1 billion Rial in education sector, income of energy sector, services sector, Health sector, agricultural sector, industrial sector, and mining sector increased 0.0199, 0.0195, 0.0185, 0.0173, 0.012, and 0.0154 respectively. Among the quintile households, the fifth quintile Urban with 0.038 billion will have the greatest impact on expansion of the training and the total household income will increase to the extent of 0.229 billion.Conclusion: Expansion or regards to Education sector caused increase of income in household’s quintiles equally, in result, this issue reduced inequality, thus providing of free education will increase household welfare, economic growth and ultimately the economic development will be strengthened.

Background: Human Development Index (HDI) is a composite indicator that can show the impact of economic strategies on human life standards. The index is calculated by three main factors of income, education and health. This research studies the status of HDI across the Iranian provinces, its changes over time and the efficiency of provinces in using resources.Methods: The data for 2001 and 2009 was obtained from the Iranian Center of Statistics. Data envelopment analysis technique was used to analyze the data. To calculate the efficiency, Banker, Charnes and Cooper's model was used.Results: The national mean for the HDI in 2001 was 0.717 while it grew to 0.747 in 2009. Except for one province, all others had an improved human development index. Low ranked provinces such as Sistan & Baluchistan and Kurdistan stayed at the bottom in 2009 as well. Some provinces such as Bushehr with developing oil industries, or those purposively benefited from national oil income showed good growth. In some provinces, such as Hormozgan, out-migration of manpower to its neighboring province, Bushehr, was associated with decrease of the provincial income level. The number of efficient provinces increased from 5 to 13 in 2009.Conclusion: Iran falls among countries with high human development index based on the 2009 data. However, the distribution of HDI status across provinces was highly varied and the difference between high- and low-developed provinces increased in 2009. The government needs to revise policies concerning distribution of resources among the provinces.