Objectives: The aim of this study was to determine budget impact of conversion from cyclosporine (CsA) to sirolimus (SRL) in renal transplant therapy (RTT) from the perspective of insurance organizations in Iran.
Methods: An Excel-based model was developed to determine cost of RTT, comparing current CsA based therapy to an mTOR inhibitor-based therapy regimen. Total cost included both cost of immunosuppressive agents and relative adverse events. The inputs were derived from database of Ministry of Health and insurance organizations, hospital and pharmacy based registries, and available literature that were varied through a one-way sensitivity analysis. According to the model, there were almost 17,000 patients receiving RTT in Iran, out of which about 2,200 patients underwent the operation within the study year. The model was constructed based on the results of a local RCT, in which test and control groups received CsA, SRL, and steroids over the first 3 months posttransplantation and, from the fourth month on, CsA, mycophenolate mofetil (MMF), and steroids were used in the CsA group and SRL, MMF, and steroids were administered in the SRL group, respectively.
Results: The estimated cost of RTT with CsA was US$4,850,000 versus US$4,300,000 receiving SRL. These costs corresponded to the cost saving of almost US$550,000 for the payers.
Conclusion: To evaluate the financial consequence of adding mTOR inhibitors to the insurers' formulary, in the present study, a budget impact analysis was conducted on sirolimus. Fewer cases of costly adverse events along with lower required doses of MMF related to SRL based therapies were major reasons for this saving budgetary impact.
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http://dx.doi.org/10.2147/CEOR.S51446 | DOI Listing |
Sci Total Environ
January 2025
Alfred Wegener Institute, Helmholtz Centre for Polar and Marine Research, Bremerhaven, Germany.
The West Antarctic Peninsula (WAP) is a hotspot of climate warming, evidencing glacier retreat and a decrease in the fast-ice duration. This study provides a > 30-y time-series (1987-2022) on annual and seasonal air temperatures in Potter Cove (Isla 25 de Mayo/King George Island). It investigates the interaction between warming, glacial melt, fast-ice and the underwater conditions (light, salinity, temperature, turbidity) over a period of 10 years along the fjord axis (2010-2019), and for the first time provides a unique continuous underwater irradiance time series over 5 years (2014-2018).
View Article and Find Full Text PDFExplore (NY)
December 2024
Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran. Electronic address:
Background: Sleep disturbances are common among individuals with leukemia, and they can significantly impact their overall well-being. Acupuncture and foot reflexology, two alternative therapies rooted in traditional Chinese medicine, have gained recognition for their potential to address sleep issues and alleviate associated symptoms.
Methods: This single blinded, three-groups randomized controlled trial was navigated at Tohid Hospital, involving 132 leukemia patients divided into acupuncture (n = 44), foot reflexology (n = 44), and control (n = 44) groups via random card selection.
PLOS Glob Public Health
January 2025
Department of Population, William H. Gates Sr. Institute for Population and Reproductive Health, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
Traditional engagement with local governments often relies on financial and human resources from international or local partners, leading to direct implementation by organizations, which can hinder sustainability. While some organizations include sustainability indicators, few focus on transferring technical and financial ownership to governments. The Challenge Initiative (TCI) uses a phased coaching model-lead, assist, observe, and monitor-to build local government capacity for scaling family planning (FP) and adolescent and youth sexual and reproductive health (AYSRH) programs.
View Article and Find Full Text PDFSci Rep
January 2025
Electrical Engineering Department, Kerman Branch, Islamic Azad University, Kerman, Iran.
In this paper, a robust fuzzy multi-objective framework is performed to optimize the dispersed and hybrid renewable photovoltaic-wind energy resources in a radial distribution network considering uncertainties of renewable generation and network demand. A novel multi-objective improved gradient-based optimizer (MOIGBO) enhanced with Rosenbrock's direct rotational technique to overcome premature convergence is proposed to determine the problem optimal decision variables. The deterministic optimization framework without uncertainty minimizes active energy loss, unmet customer energy, and renewable generation costs.
View Article and Find Full Text PDFJ Manag Care Spec Pharm
January 2025
Global Value and Real-World Evidence, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ.
Background: Bipolar disorder is a severe recurrent, episodic psychiatric condition with a worldwide prevalence of approximately 1%, affecting more than 5 million adults in the United States in 2020. A subtype, bipolar I disorder (BP-I), which accounts for approximately one-quarter of cases, is associated with impairments in psychosocial functioning and quality of life. Recommended treatment options include daily oral, or long-acting injectable, antipsychotics, including the aripiprazole once every month formulation, which has been shown to improve adherence compared with oral treatments.
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