Among different groups of hemophiliacs, those suffering from Severe Hemophilia A (SHA) are most vulnerable to the complications of the disease. This study investigated the Health-Related Quality of Life (HR-QoL) among adult patients with SHA. A cross-sectional study was designed to gather demographic and clinical information from adult patients with SHA. Patients with inhibitors were excluded. The remaining were asked to complete the HR-QoL questionnaire after being examined for joint health using the Hemophilia Joint HealthScore (HJHS). The HR-QoL and joint conditions were measured in 38 patients. The mean EQ-5D value scores were 0.46 (SD=0.23) while the mean Visual Analogous Scale score was 50 (SD=18.7). The clinical examination of patients indicated that the HJHS were as follows: eight patients had a score of 55-75, 12 patients had a score of 40-55, 7 of them (25-40) and 11 patients had a score of 10-25. The results obtained from this study showed that HR-QoL in hemophilia patients was considerably low. Pain, anxiety/depression, and motion limitations were the main causes of the disutility for these patients respectively.

Background The quality of health care has a significant impact on both patients and the health system in terms of long-term costs and health consequences. This study focuses on determining the long-term cost-effectiveness in quality of diabetes care in two different settings (private/public) using longitudinal patient-level data in Iran. Methods By extracting patients intermediate biomedical markers in under-treatment type 2 diabetes patients(T2DP) in a longitudinal retrospective study and by applying the localized UKPDS diabetes model, lifetime health outcomes including life expectancy, quality-adjusted Life expectancy (QALE) and direct medical costs of managing disease and related complications from a healthcare system perspective was predicted. Costs and utility decrements had derived on under-treatment T2DP from 7 private and 8 Public diabetes centers. We applied two steps sampling mehods to recruit the needed sample size (cluster and random sampling). To cope with first and second-order uncertainty, we used Monte-Carlo simulation and bootstrapping techniques. Both cost and utility variables were discounted by 3% in the base model. Results In a 20-year time horizon, according to over 5 years of quality of care data, outcomes-driven in the private sector will be more effective and more costly (5.17 vs. 4.95 QALE and 15,385 vs. 8092). The incremental cost-effectiveness ratio (ICER) was $33,148.02 per QALE gained, which was higher than the national threshold. Conclusion Although quality of care in private diabetes centers resulted in a slight increase in the life expectancy in T2DM patients, it is associated with unfavorable costs, too. Private-sector in management of T2DM patients, compared with public (governmental) diabetic Centers, is unlikely to be cost-effective in Iran.

management of the disease. Therapies that reduce significantly this clinical indicator eABRare key for increasing the efficiency in the healthcare spend and improve the clinical outcome of patients.OBJECTIVES: Management of hemophilia B requires factor IX (FIX) infusions to replenish missing coagulation factor. Newer extended half-life (EHL) replacement products with longer half-lives compared to standard half-life (SHL) products are available in the US. In this exploratory analysis of US claims data, we compared the expenditures and dispensation of two EHL products versus an SHL product for hemophilia B treatment. METHODS: De-identified claims from a large national specialty pharmacy dispensation claims database were used to identify male patients with severe hemophilia B who received FIX replacement from May 2016 (first month of albutrepenonacog alfa dispensation) to September 2017 and had 1 month of dispensation data. Two patient groups (SHL vs. EHL) were compared. Key outcome measures were direct expenditures and factor IUs dispensed, measured over monthly increments. Descriptive statistics were used to analyze results. Medians for expenditures and IUs were used to accommodate data distribution skewing. RESULTS: 213 Hem B patients met the inclusion criteria and were included in the analysis, including patients who were dispensed >1 FIX product. The SHL (nonacog alfa) group comprised 133 patients; the EHL group included 72 patients in the eftrenonacog alfa group and 39 patients in the albutrepenonacog alfa group. The median per-patient-per-calendar-month FIX product dispensation was 20,456 IU (interquartile range [IQR], 28,896 IU; nonacog) versus 17,438 IU (IQR, 16,483 IU; eftrenonacog) and 10,453 IU (IQR, 8377 IU; albutrepenonacog). Median per-patient-per-calendar-month expenditures were higher for EHLs

Aim: This study aimed to perform an economic evaluation of Hemophilia ambulatory service delivery model (HASDM) comparing to the traditional home-episodic treatment model. Study Design: Tehran university of medical science, department pharmacoeconomics and pharmaceutical administration, between Jun 2016 and September 2018. Methods: A cost-minimization analysis (CMA) was conducted for evaluating potential savings of HASDM in comparison to the traditional home-episodic treatment model. The main cost of regular episodic service delivery, basic arm, consists of the cost of recombinant factor VIII (FVIII). In the comparator arm, HASDM, the costs of HASDM for 1660 hemophilia A patients (HAPs) in Tehran were calculated. One-way sensitivity analysis was done to investigate the robustness of the results and to investigate the impact of uncertainty in the percentage of mistakes in bleeding sensation. Results: There were 1660 patients with severe Hemophilia A (PWSHA) in Tehran in 2018. The mean utilization of annual per patient FVIII was 44814 international units (IUs) in Iran. The total annual cost of FVIII concentrate for 1660 hemophilic patients in Tehran was estimated at $ 11,001,816. The cost of running HASDM, personal, and equipment is equal to $ 580,956. The cost of FVIII in HASDM would be $ 4,004,661. Therefore, the total cost of HASDM is estimated at $ 4,585,617. The amount of savings was $ 6,416,199. Sensitivity analysis indicated the robustness of the results up to 94.64% of the variation in the model parameters. Conclusions: HASDM, compared to episodic model, can save 58.32% of the funding for controlling bleeding in HAPs annually. This can save more than 38 times of HAPs annual cost over their lifetime.

BackgroundThe quality of health care provided to diabetic patients has a significant impact on long-term costs and health outcomes. This study aims to determine the long-term cost-effectiveness analysis between private and public Diabetic Centers in Iran.MethodsUsing the localized UKPDS model, we performed a cost-effectiveness analysis to forecast 20 years quality-adjusted life expectancy (QALE) gains and direct medical costs(management of complications and Treatment Costs) in under-treatment patients referred to private and public Diabetic Centers in Iran. Costs and utility decrements derived from 1978 patients with type 2 diabetes from 7 private and eight Public diabetes centers in 5 provinces. We used statistical techniques (internal loops (Monte-Carlo trials) and bootstraps) to examine the robustness of the results.ResultsIn a 20-year time horizon, the private sector will be more effective and more costly(5.17 vs 4.95 QALE and 15385 vs 8092 ). The incremental cost-effectiveness ratio (ICER) was $33,148.02 per QALE gained that was higher than our country threshold.Conclusion Although the pattern and quality of care in private-sector diabetes centers resulted in a slight increase in the life expectancy of T2DM patients, it is associated with unfavorable costs too.