Cost of lung cancer in East Azerbaijan province, in Iran, in 2017

Economic burden of diabetic foot ulcer: a case of Iran

BACKGROUND

Diabetic foot ulcer (DFU) is known as a serious complication of diabetes mellitus in patients with diabetes, imposing heavy medical costs on healthcare systems due to its chronic nature. patients with severe diabetic foot ulcer are often disabled to work, and some of them may even die, leading to associated productivity losses. Since no previous study has investigated the economic burden of DFU in Iran, this study is to estimate the economic burden of diabetic foot disease in Iran.

METHODS

In this descriptive cross-sectional study, randomly selected samples consisted of 542 patients with DFU, hospitalized in the hospitals of Shahid Beheshti University of Medical Sciences. The demographic profile and cost data used in this analysis were derived from a researcher-designed checklist. Lost productivity was calculated based on Human Capital Approach, and the total economic cost of DFU was determined using patient-level data on costs and prevalence data from the global burden of diseases reports. All analyses were performed using SPSS software (Version 23), and Microsoft Excel (Version 19).

RESULTS

The economic burden of DFU in Iran in two scenarios of discounting future costs and not discounting them was about $8.7 billion and $35 billion, respectively (about 0.59 and 2.41% of GDP). 79.25% of the estimated costs in this study were indirect costs and productivity losses, of which 99.34% (7,918.4 million Dollars) were productivity losses due to premature death. 20.75% (2,064.4 million dollars) of the estimated costs in this study were direct costs. The average length of stay (LOS) was 8.10 days (SD = 9.32), and 73.3% of patients recovered and were discharged after hospitalization and 7.6% died. The majority of the costs are imposed on the age group of 60-69 year (53.42% of the productivity lost due to hospital length of stay, 58.91% of the productivity lost due to premature death & 40.41% of direct costs).

CONCLUSIONS

DFU represents a heavy burden to patients, Iran's health system, and the economy. Early prevention strategies need to be prioritized in making public health policies. These policies and decisions can be in the area of changing lifestyle, health education, changing people's behavior, and encouraging physical activity that targeted high-risk populations in order to reduce the prevalence of diabetic foot and resulting substantial economic burden.

Cost of Lung Cancer: A Systematic Review

OBJECTIVES

We performed a systematic review of studies estimating the cost of illness of lung cancer to compare costs between studies and examine cost drivers, emphasizing generalizability and methodological choices.

METHODS

A systematic search on studies published in English on cost of illness of lung cancer was performed in MEDLINE (PubMed), Embase, Web of Science, and Scopus. Databases were searched in January 2017, and records were screened based on eligibility criteria. The systematic search was updated on May 7, 2020. The quality of included studies was appraised using a modified Drummond checklist.

RESULTS

Of the 4891 records screened, 19 records were included. Most of the studies were cross-sectional and retrospective and used a prevalence-based approach and a bottom-up approach. Direct medical costs ranged from 4484.13 US dollars purchasing power parity to 45 364.48 US dollars purchasing power parity. Total medical costs as a percentage of total gross domestic product (GDP) ranged from 0.00248 to 0.1326 (median 0.0217), and total medical costs as a percentage of total health expenditure ranged from 0.038 to 0.836 (median 0.209).

CONCLUSIONS

There was considerable methodological heterogeneity that made it difficult to compare results between studies. The costs of lung cancer are substantial and impose a substantial economic burden on patients, healthcare systems, and societies. By comparing cancer costs with total health expenditures and GDP per capita, it can be concluded that lung cancer imposes a considerable economic burden on patients and healthcare systems in countries with lower GDP per capita and higher incidence rate.

Cost-effectiveness analysis of lung cancer screening with low-dose computed tomography in an Iranian high-risk population

OBJECTIVE

The results of recent studies have shown that using low-dose computed tomography (LDCT) for screening of lung cancer (LC) improves cancer outcomes. The objective of the current study was to evaluate the cost-effectiveness of LDCT in an Iranian high-risk population.

METHODS

A Markov cohort simulation model with four health states was used to evaluate the cost-effectiveness of LDCT from a healthcare system perspective in the people aged 55-74 who smoked 25 or more cigarettes per day for 10-30 years. Cost data were collected, reviewing 324 medical records of patients with LC, and utilities and transition probabilities were extracted from the literature. The Monte Carlo simulation method was applied to run the model. Probabilistic sensitivity analysis and one-way analysis were also performed.

RESULTS

LC screening in comparison to a no-screening strategy was costly and effective. The incremental cost-effectiveness ratio of screening versus no-screening was IRR (Iranian rials) 98,515,014.04 which falls below the Iranian threshold of three times GDP (gross domestic product) per capita. One-way and probabilistic sensitivity analyses demonstrated that the results of the economic analysis were robust to variations in the key inputs for both.

CONCLUSIONS

Using LDCT for screening of LC patients in a high-risk population is a cost-effective strategy.