24 research outputs found
Evaluation of productivity in Iranian pharmaceutical companies: A DEA-based Malmquist approach and panel data analysis
No full textObjective: In this study, we aimed to assess comparative productivity of 21 pharmaceutical companies in Iran during 2000-2013.
Methods: To evaluate the productivity trend of pharmaceutical companies in Iran, we used data envelopment analysis-based Malmquist index. "Total assets" and "capital stock" as inputs and "net sales" and "net profit" as outputs extracted from Tehran stock exchange, were selected to be included in the analysis. This method provides the possibility for analyzing the performance of each company in term of productivity changes over time. We also used an estimation generalized least square panel data model to identify the factors that might affect productivity of pharmaceutical companies in Iran using EViews 7 and Deep 2.1 software.
Findings: The mean total productivity during all years of the study was 0.9829, which indicates the improvement in their overall productivity. The results, over the 13-year period, indicated that the range of productivity changes in pharmaceutical companies, that were included in this study, was between 0.884 and 1.098. Panel data model indicated that age of company could positively (t = 4.765978, P < 0.001) and being located in cities other than Tehran (the capital) could negatively (t = −5.369549, P < 0.001) affect the productivity of pharmaceutical companies. The analysis showed the new policy (brand-generic scheme) and also the type of ownership did not have a significant effect on the productivity of pharmaceutical companies.
Conclusion: In this study, pharmaceutical productivity trends were fluctuated that could be due to the sub-optimal attention of policy makers and managers of pharmaceutical companies toward long-term strategic planning, focusing on productivity improvement
Psychometrics of Assessment Tools to Examine the Challenges of Physicians\' Participation in Accreditation Programs
No full textBackground: Many organizations believe that physician involvement is important in quality and safety of health services, but they did not properly define, measure, and improve it, so because of the importance of the quality of health care and increasing the involvement of physician this study was conducted to evaluate the validity and reliability of a questionnaire on the challenges of physicianschr('39') participation in quality improvement programs.
Methods: In this cross-sectional study conducted in the hospitals of Mashhad University of Medical Sciences, a researcher-made questionnaire about challenges of physicianschr('39') participation in accreditation activities used for data gathering. The content validity ratio index and content validity index were also calculated. To measure the internal consistency of the instrument, the questionnaire was distributed among 14 physicians, Cronbachchr('39')s alpha coefficient was determined. For stability or reproducibility of the instrument, test - retest and correlation coefficient were calculated. By distributing questionnaires among 14 people those meeting inclusion criteria, the correlation coefficient was measured twice and at intervals of 2 weeks. SPSS 21 software was used for data analysis
Results: The initial questionnaire was consisted of 61 items, which were reduced to 38 items after face and content psychometrics. The questionnaire has 12 sub-concepts. Cronbachchr('39')s alpha coefficient of the questionnaire was 0.83 and the intragroup correlation coefficient in 2 measurements 2 weeks apart was 0.94.
Conclusion: This questionnaire is the first and only valid and reliable dedicated tool in the field of challenges of physicianschr('39') participation in accreditation activities in Iran, which can measure and prioritize the challenges in each health center and it can be used to improve health care quality services that are performed by doctors
Estimating the out‐of‐pocket health expenditure in patients under 5 years with severe malnutrition in Afghanistan in 2023: Findings from a cross‐sectional study
No full textAbstract Introduction This study, of significant importance to healthcare professionals, policymakers, researchers, and organizations involved in child healthcare and malnutrition in Afghanistan, aimed to estimate the out‐of‐pocket expenditure (OOPE) in patients under 5 years old with severe malnutrition in a children's hospital in Herat Province, Afghanistan. Method This study employed a meticulously designed cross‐sectional descriptive‐analytical approach with practical results. The research population consisted of families with malnourished children under 5 who were referred to Herat Children's Hospital. Data was collected using a comprehensive standard World Health Organization questionnaire to gather demographic information from children in Herat. A carefully selected convenience sampling method was used, with 300 referring patients participating in face‐to‐face interviews with the supervisors of these children. After obtaining personal consent and coordinating with health officials, interviews were conducted with the caregivers of children under 5 who suffered from severe malnutrition. The data was then analyzed using robust descriptive statistics, quantitative variables, mean and standard deviation, frequency, and relative frequency. Multiple regression analysis was used to determine the factors that most influenced direct payments from patients' pockets, ensuring the reliability and validity of the findings. Results The results showed that OOPE in both households with seven and less than seven people and more than seven people was 68%. The findings indicated that among the residents of Herat referred to the studied hospital, these people spent 54% of the treatment costs directly out of pocket. In contrast, people in the rural areas of Herat pay 69% of the treatment costs to receive medical services straight out of pocket. The critical point is that 93% of the families have incurred catastrophic expenses to treat their children suffering from severe malnutrition. The research revealed that the patient's location and the education level of the head of the household were the most significant factors affecting out‐of‐pocket payments by patients. Conclusion Increasing OOPE in rural Afghanistan poses a significant obstacle to equitable healthcare services and access to appropriate medicines. To support the goal of universal healthcare coverage, geographic imbalances, and broad health financing options must be addressed. Strengthening insurance coverage and more government assistance can significantly reduce these patients' out‐of‐pocket payments
The prevalence of adolescent pregnancy and its associated consequences in the Eastern Mediterranean region: a systematic review and meta-analysis
No full textAbstract Background Adolescent pregnancy is one of the public health problems that both mother and baby suffer from its consequences. This study was conducted to estimate the prevalence and consequences of adolescent pregnancy in the Eastern Mediterranean region. Methods In this systematic review and meta-analysis, four databases (PubMed, ProQuest, Web of Science and Scopus) were systematically searched for relevant articles published from 1990 to 2022. The screening process for articles was conducted in accordance with the PRISMA guidelines. Joanna Briggs checklists were used to assess the quality of included studies. A random effects model was performed for the meta-analysis. Narrative synthesis of adolescent pregnancy prevalence, as well as a meta-analysis of adolescent pregnancy prevalence was performed using STATA 14. Results The review included 12 studies and 94,189 study participants. The prevalence of adolescent pregnancy was [9% (95% CI 6.9, 11.2, p < 0.001)]. Pregnancy outcomes included preeclampsia [12.9%(95% CI 7.3,18.5, p < 0.001)], low birth weight [16.1%(95% CI 7.4–24.8, p < 0.001)], anemia [33%(95% CI 14.4, 51.7, p < 0.001)], and cesarean delivery [15.9%(95% CI 11.1–20.7, p < 0.001)].The results showed that 16.9% of deliveries were cesarean sections. Conclusion The study's findings indicate that adolescent pregnancy is prevalent in the Middle East region and is associated with negative outcomes for teenagers. Therefore, it is necessary to carry out effective interventions to reduce adolescent pregnancy
From generic scheme to brand-generic scheme: Have new policy influenced the efficiency of Iranian pharmaceutical companies?
No full textObjective: Brand-generic scheme was implemented in Iran to improve the competition in the pharmaceutical market. In this study, we aim to assess if this policy had any positive effect on efficiency of Iranian pharmaceutical companies.
Methods: We used data envelopment analysis to evaluate the relative efficiency of pharmaceutical companies during 1999-2008. The Wilcoxon matched-pairs signed-rank and sign tests were used to assess the difference between mean technical efficiency of companies before and after implementation of the new policy.
Findings: Although the Wilcoxon matched-pairs signed-rank tests did not show any significant differences in favor of the new policy in terms of both relative and pure (managerial) technical efficiency for included companies (P = 0.079 and 0.07, respectively), but the one-sided sign test indicated that only relative pure (managerial) efficiency has been improved after this policy (P = 0.031).
Conclusion: The "brand-generic scheme" does not seem to be a successful policy to improve efficiency level and prompt competition in pharmaceutical companies in Iran. To achieve this aim, consideration of infrastructural requirements including transparent and non-discriminating laws and regulations to support competition, the competitive pricing policies, the presence of international companies in the market, and full privatization of companies had to be also deeming by policy makers
The cost effectiveness of intensity-modulated radiation therapy and three-dimensional conformal radiotherapy in the treatment of head and neck cancers
No full textAbstract Purpose Intensity-modulated radiotherapy is developed as a replacement for 3-dimensional conformal radiation therapy. Considering the difference in costs and effectiveness of these interventions, the aim of this study was to compare the cost effectiveness of intensity-modulated radiation therapy and three-dimensional conformal radiotherapy in the treatment of head and neck cancer in east of Iran. Methods A Markov model including six states based on xerostomia and dysphagia was developed to estimate the incremental cost effectiveness ratio from the perspective of societal. Cost and quality of life data were collected from 97 respondents via a checklist and EuroQol-5Dimension questionnaire. The robustness of results was examined by deterministic and probabilistic sensitivity analysis. All analysis were conducted with Treeage software. Results The results of this study showed that the cost and quality adjusted life years for 3-dimensional conformal radiation therapy were 9209.76 and 3.63 respectively. However, the cost and quality adjusted life years for intensity-modulated radiotherapy were 12562.90 and 3.17 respectively. Therefore, 3-dimensional conformal radiation therapy produced 0.45 more quality adjusted life years than intensity-modulated radiotherapy and saved 7367.27 per quality adjusted life years. These results confirmed by sensitivity analysis. Conclusion This study concluded that in the treatment of head and neck cancer, the 3-dimensional conformal radiation therapy method appears to be cost-effective when compared with intensity-modulated radiotherapy
Estimating the Direct Medical Costs of Smoking-Attributable Non-communicable Diseases in Northeastern Iran From 2015 to 2023
No full textIntroduction: Smoking remains a significant public health issue, leading to severe non-communicable diseases (NCDs) and a considerable economic burden, particularly in low- and middle-income countries. In Iran, smoking-attributable diseases account for substantial healthcare costs. This study aims to estimate the direct medical costs of smoking-attributable NCDs in hospitals affiliated with Mashhad University of Medical Sciences from 2015 to 2023. Methods: A descriptive-analytical study was conducted using a cross-sectional design, analyzing hospital records from 2015 to 2023. The study population included all patients aged 35 and older with smoking-attributable NCDs hospitalized during this period. The smoking-attributable fraction (SAF) was calculated using prevalence data for current and former smokers and relative risk estimates for various NCDs. Direct medical costs were extracted from the hospital information system and analyzed using Microsoft Excel 2019 and STATA 14 software. Results: The total direct medical costs of smoking-related NCDs averaged $10.5 million annually, with male patients accounting for 93.4% of these costs. Cardiovascular diseases were the largest cost driver, comprising 74.1% of the total expenses, followed by respiratory diseases (15.2%) and cancers (10.7%). The attributable risk for smoking-related diseases was consistently higher in men, particularly for lung cancer (76.9%) and chronic obstructive pulmonary disease (68.3%). Conclusion: Smoking imposes a significant financial burden on the healthcare system, particularly for male patients. Targeted tobacco control interventions, such as increased taxation and public awareness campaigns, are urgently needed to reduce smoking prevalence and mitigate its economic impact on healthcare systems. Comprehensive policies could alleviate the strain on Iran’s healthcare system and improve public health outcomes
Developing a patient satisfaction questionnaire for services provided in Iranian community pharmacies
No full textObjective: To develop a valid and reliable instrument in the Persian language for evaluating patient satisfaction with services provided in community pharmacies.
Methods: We selected a valid and reliable instrument from the literature and translated it to the Persian language. Some new items were added to the first draft based on the special characteristics of the Iranian health system. Then, the feasibility of utilizing the new instrument was assessed. In the third step, we conducted a formal content validity study to calculate content validity indices. Having completed the content validity study, the factorial structure of new instruments was determined by implementing a factorial analysis. Finally, the reliability of the instrument was assessed by assessment of Cronbach′s alpha coefficient and test-retest reliability.
Findings: The developed instrument demonstrated suitable validity and reliability. The final instrument showed desirable content validity, with inter-rater agreement of 94% and 97% for relevance and clarity, respectively. Scale content validity indices for relevance and clarity were calculated as 96% and 92%, respectively, and comprehensiveness was calculated as 100%. Factor analysis resulted in seven factors with a cumulative variance of 62.14%. In internal consistency reliability, Cronbach′s alpha for the whole instrument was 0.912. About test-retest reliability, six items showed "almost perfect" agreement, 18 items showed "substantial" agreement, and three items showed "moderate" agreement. Therefore, test-retest reliability assessment too demonstrated appropriate results.
Conclusion: The instrument demonstrated excellent validity and reliability for application in Iran. This instrument is useful for evaluating patient satisfaction with services provided in community pharmacies in the Persian-speaking communities
