Background: Alemtuzumab and natalizumab are approved as second-line therapies for relapsing-remitting multiple sclerosis (RRMS) patients in Iran who have shown an inadequate response to other disease-modifying therapy (DMT). In the absence of head-to-head trials, evaluations based on decision analytic modeling may be a suitable alternative to compare alemtuzumab and natalizumab in RRMS. Purpose: To evaluate the cost-effectiveness of alemtuzumab compared with natalizumab in RRMS in Iran, based on an indirect comparison of clinical trial data. Methods: A cost-utility analysis was conducted using a cohort-based Markov model to analyze cost-utility in a cohort of 1000 RRMS patients treated with alemtuzumab or natalizumab who had failed at least one previous DMT. Costs were measured in 2018 US Dollars, and were estimated from both the societal and National Healthcare Service (NHS) perspective over a 20-year time horizon in Iran. One-way deterministic sensitivity analyses were carried out to investigate the impact of individual variables on model results. Result: Alemtuzumab dominated natalizumab in both NHS and societal perspective analyses. From the NHS perspective, the total discounted costs per patient were estimated at $147,417 and $150,579 for alemtuzumab and natalizumab, respectively, over 20 years. The discounted quality-adjusted life years were estimated to be 7.07 and 6.05, respectively. Results were similar for the societal perspective analysis. Results were most sensitive to acquisition costs and the time horizon, while no sensitivity was observed for Expanded Disability Status Scale (EDSS) health-states utility, relapse relative risk, adverse event or EDSS-related costs, and laboratory/monitoring costs. Conclusion: Alemtuzumab was dominant in the treatment of RRMS compared with natalizumab due to lower total cost, greater efficacy and slowing of disease progression, and lower rate of relapses over a 20-year time horizon in Iran. Comparative head-to-head trials and long-term follow-up are needed to confirm these results.

Aim: This study estimated the GDP share of pharmaceuticals in Iran based on the drivers of pharmaceutical expenditure and compared it with that of 31 members of the Organisation for Economic Cooperation and Development (OECD). Subject and methods: The factors contributing to pharmaceutical expenditure were identified through literature review and studied by 8 experts to classify the factors. Then, using the panel data method, a model was built to estimate the GDP share of pharmaceutical expenditure based on the extracted factors of the selected countries in Iran’s model. To explain the observed differences, several regression analyses were performed based on cross-sectional data. The analyses were performed using EVIEWS software, version 10. Results: The explanatory variables for the selected countries in the panel model (R² = 0.98) were specified. Government health expenditure (β = 0.1432), the share of generic drugs (β = − 0.0143), gross domestic product (GDP) per capita (β = − 0.0058) and the rate of disability-adjusted life-years (DALY) (β = 0.0028) contributed most to pharmaceutical expenditure. In comparison, in the Iranian estimation model (R² = 0.84), government health expenditure (β = 0.0536) and the share of generic drugs (β = 0.0369) had a significant impact on pharmaceutical expenditure. In the estimation model with more estimators for Iran (R² = 0.99), government health expenditure (β = 0.1694), disease prevalence (β = 0.0537), the share of generic drugs (β = 0.0102), the DALY rate (β = 0.0039), GDP per capita (β = − 0.0033), and the drug price index (β = 0.0007) contribute most to pharmaceutical expenditure. Conclusion: In the models of the study, factors related to the structure of the healthcare system and the pharmaceutical system contributed most to pharmaceutical expenditure as a share of GDP. Moreover, disease profiles show its predictive role in the second model for Iran.

The prevalence of common cold can impose financial burden on the healthcare systems, despite its simple and self-limiting symptoms. This study examines the behavior of patients suffering from symptoms of the common cold and explores the factors that may influence such behaviors. A descriptive-analytic cross-sectional study was conducted in 2019, in Tehran, Iran, using cluster sampling in socioeconomically diverse areas within the city. The participants' behaviors and related factors were evaluated using a 10-item questionnaire. Data collection process involved selecting 5 shopping centers and 404 individuals participated the study. SPSS version 24 was used for analysis. The results showed that 42.1% of the respondents would consult a physician immediately upon experiencing cold symptoms, while 11.4% would consult a pharmacist. In addition, 14.3% would try self-medication, 28.3% relied on traditional home remedies, and 15%indicated not to make use of any remedies or interventions. The study indicated a correlation between people's behaviors concerning the common cold and their level of health self-confidence, knowledge of the common cold, lifestyle, gender, marital status, occupational status, insurance status, and average family spending. The findings of this study are significant in that they shed light on the behaviors of individuals and associated factors related to seeking medical assistance for the common cold. This knowledge can assist healthcare systems in developing strategies aimed at enhancing treatment outcomes, and decreasing costs.

Objectives: This study was aimed to systematically review published economic studies to determine whether dapagliflozin, a sodium-glucose co-transporter inhibitor, plus standard care therapy (SCT) is cost-effective in heart failure with reduced ejection fraction (HFrEF). Method: We searched relevant keywords in PubMed, Scopus, Web of science, and Google Scholar to find related articles. Costs, QALYs, ICERs were extracted from eligible studies. Results: Ten studies finally included in the systematic review. The results of quality assessment of the study showed that a reasonable quality of all studies. Incremental QALYs were in favor of dapagliflozin plus SCT treatment regimen. In all the studies, the incremental costs per QALY was below the willingness-to-pay (WTP) threshold with the exception of one study in United Kingdom which the ICER and WTP were $83,650 and $50,000. All the studies determined the National Health Care perspective. The highest and lowest ICERs were $83,650 and $1991 per QALY in United Kingdom and Thailand, respectively. Conclusion: Results of cost-effectiveness analyses showed that adjunct dapagliflozin plus SCT is cost-effective compared to SCT alone despite the additional costs of the drug. Finally it can be concluded that dapagliflozin is a worldwide cost-effective as an adjunct medicine in HFrEF management.

Purpose: Pharmaceutical market value in Iran exceeded to more than US$4bn in 2013, indicating annually over 20 per cent growth. In the past decades, Iranian pharmaceutical industry was supported by government policies, namely, generic substitution, import limitation and local production support; however, the local pharmaceutical manufacturer’s market share in value has been decreased gradually. This study aims to provide historical data on Iran pharmaceutical market to show the importance of new product development to attain greater market share and tries to motivate the pharmaceutical industry located in developing countries to develop more innovative medicines. Design/methodology/approach: This is a descriptive cross-sectional study that investigates the Iranian pharmaceutical market by focusing on new products over a five-year period (2009-2014), and that was augmented by an expert panel to rank subjectively firms’ performance indicators to shed light on the importance of new product development to firms’ performance. Findings: The expert panel results find out that new product development is one of the most important “result indicators” for Iranian pharmaceutical companies. Historically, in line with the experts’ opinion on the new product development, the Iranian pharmaceutical industry has shown its capability to develop new medicines by developing 3,095 new products (mostly new-to-firm) across about 100 firms. Despite this fact, the share of local manufacturers in new medicines’ market decreased from 52 per cent at the beginning of studied period to 24 per cent at the end, and the gap between the unit value of imported and domestically produced medicines has been significantly increased due to low-innovative medicines locally produced. Research limitations/implications: This research was challenged with limitations such as lack of reliable published data on new medicines in the Iran pharmaceutical market. Practical implications: This study highlights the fact that developing more innovative products in the generic pharmaceutical industry such as Iran can grant its market share. Originality/value: This is an original study that shows the effect of innovative product development on market share through historical data.