BackgroundBreast cancer is the most common cancer in Iranian women as is worldwide. Mammography screening has been introduced as a beneficial method for reducing mortality and morbidity of this disease.ObjectivesWe developed an analytical model to assess the cost effectiveness of an organized mammography screening program in Iran for early detection of the breast cancer.Patients and MethodsThis study is an economic evaluation of mammography screening program among Iranian woman aged 40 - 70 years. A decision tree and Markov model were applied to estimate total quality adjusted life years (QALY) and lifetime costs.ResultsThe results revealed that the incremental cost effectiveness ratio (ICER) of mammography screening in Iranian women in the first round was Int. $ 37,350 per QALY gained. The model showed that the ICER in the second and third rounds of screening program were Int. $ 141,641 and Int. $ 389,148 respectively.ConclusionsStudy results identified that mammography screening program was cost-effective in 53% of the cases, but incremental cost per QALY in the second and third rounds of screening are much higher than the accepted payment threshold of Iranian health system. Thus, evaluation of other screening strategies would be useful to identify more cost-effective program. Future studies with new national data can improve the accuracy of our finding and provide better information for health policy makers for decision making.

Background:Choosing an appropriate accounting system for hospital has always been a challenge for hospital managers. Traditional cost system (TCS) causes cost distortions in hospital. Activity-based costing (ABC) method is a new and more effective cost system.Objective:This study aimed to compare ABC with TCS method in calculating the unit cost of medical services and to assess its applicability in Kashani Hospital, Shahrekord City, Iran.Methods:This cross-sectional study was performed on accounting data of Kashani Hospital in 2013. Data on accounting reports of 2012 and other relevant sources at the end of 2012 were included. To apply ABC method, the hospital was divided into several cost centers and five cost categories were defined: wage, equipment, space, material, and overhead costs. Then activity centers were defined. ABC method was performed into two phases. First, the total costs of cost centers were assigned to activities by using related cost factors. Then the costs of activities were divided to cost objects by using cost drivers. After determining the cost of objects, the cost price of medical services was calculated and compared with those obtained from TCS.Results:The Kashani Hospital had 81 physicians, 306 nurses, and 328 beds with the mean occupancy rate of 67.4% during 2012. Unit cost of medical services, cost price of occupancy bed per day, and cost per outpatient service were calculated. The total unit costs by ABC and TCS were respectively 187.95 and 137.70 USD, showing 50.34 USD more unit cost by ABC method. ABC method represented more accurate information on the major cost components.Conclusion:By utilizing ABC, hospital managers have a valuable accounting system that provides a true insight into the organizational costs of their department.

Introduction: Breast cancer is the most common cancer in women. Improvements of early diagnosis modalities have led to longer survival rates. This study aimed to determine the 5, 10 and 15 year mortality rates of breast cancer patients compared to the normal female population. Materials and Methods: The follow up data of a cohort of 615 breast cancer patients referred to Iranian Breast Cancer Research Center (BCRC) from 1986 to 1996 was considered as reference breast cancer dataset. The dataset was divided into 5 year age groups and the 5, 10 and 15 year probability of death for each group was estimated. The annual mortality rate of Iranian women was obtained from the Death Registry system. Standardized mortality ratios (SMRs) of breast cancer patients were calculated using the ratio of the mortality rate in breast cancer patients over the general female population. Results: The mean age of breast cancer patients at diagnosis time was 45.9 (±10.5) years ranging from 24-74. A total of 73, 32 and 2 deaths were recorded at 5, 10 and 15 years, respectively, after diagnosis. The SMRs for breast cancer patients at 5, 10 and 15 year intervals after diagnosis were 6.74 (95% CI, 5.5-8.2), 6.55 (95%CI, 5-8.1) and 1.26 (95%CI, 0.65-2.9), respectively. Conclusion: Results showed that the observed mortality rate of breast cancer patients after 15 years from diagnosis was very similar to expected rates in general female population. This finding would be useful for clinicians and health policy makers to adopt a beneficial strategy to improve breast cancer survival. Further follow-up time with larger sample size and a pooled analysis of survival rates of different centres may shed more light on mortality patterns of breast cancer.

The operational management of healthcare services is expected to directly touch patient experiences. Iranian Ministry of Health and Medical Education (MoHME) for the first time, as such, has sought to improve the operational management of healthcare delivery within a reform agenda by setting benchmarks for ‘number of visit per hour’ and waiting time in outpatient clinics of about 700 affiliated hospitals. As a new initiative, it has faced with mixed reactions and various doubts have been cast on its successful implementation. This manuscript aims to shed some light on the operational challenges of the initiative and the requirements of its successful implementation.

BackgroundUtility values are a key component of a cost-utility analysis. The EQ-5D and SF-6D are two commonly used measures for deriving utilities. Of particular importance is assessing the performance of these instruments in terms of validity.ObjectivesThis study aimed to compare the performance of the EQ-5D and the SF-6D in different states of breast cancer.Patients and MethodsThis was a cross-sectional study of 163 patients with breast cancer who attended the breast cancer subspecialty clinic affiliated with the breast cancer research center (BCRC) at ACECR, in Tehran, Iran, and were consecutively recruited. Patients completed several questionnaires, including the EQ-5D, SF-36, and general questions regarding their demographic characteristics. Utility values for different states of breast cancer were obtained using predetermined algorithms for the EQ-5D and SF-6D. The distribution of the utility values and the differences between the different states for both instruments were statistically assessed. Furthermore, the agreement between the two instruments was evaluated using intra-class correlation coefficients and Bland-Altman plots.ResultsThe mean and median EQ-5D utility scores for the total sample were 0.685 and 0.761, respectively. The mean SF-6D utility score for the total sample was 0.653, and the median utility score was 0.640. The mean utility values of the EQ-5D for “state P,” “state R,” “state S,” and “state M” were estimated as 0.674, 0.718, 0.730, and 0.552, respectively. The SF-6D provided mean utility values of 0.638, 0.677, 0.681, and 0.587 for those states. Both instruments assigned statistically significant (P < 0.01) scores for different states. The intra-class correlation for the two measures was 0.677 (95% confidence interval (CI): 0.558 - 0.764). The Bland-Altman plot indicated a better agreement on the higher values and that at higher values, the EQ-5D yields a higher score than the SF-6D; this relationship was reversed at lower values.ConclusionsAlthough the two instruments were able to discriminate between various states, the values derived from these instruments were quite different. This distinction could have influenced the conclusions of an economic evaluation. Further research is required to determine which instrument should be used in economic evaluations.