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Ali Akbari Sari, MD, PGC, PhD Dean of School & Associate Professor School of Public Health Tehran University of Medical Sciences

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Presentation on theme: "Ali Akbari Sari, MD, PGC, PhD Dean of School & Associate Professor School of Public Health Tehran University of Medical Sciences"— Presentation transcript:

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2 Ali Akbari Sari, MD, PGC, PhD Dean of School & Associate Professor School of Public Health Tehran University of Medical Sciences akbarisari@tums.ac.ir 19 th Apr 2014, Kerman Kerman University of Medical Sciences, Iran Evidence Informed Policy Making Path to Iran Universal Health Coverage Lessons From Selected Evidence and Experiences

3 School of Public Health Tehran University of Medical Sciences

4  UHC concept and dimensions  Japanese new insurance coverage for H. pylori eradication  Management of Herceptin in breast cancer  Mammography for breast cancer  PET Scan for selected cancers  MRI for low back pain  CT Scan for head trauma  CT coronary angiography for CAD  Malaria control and elimination programs  Diabetes and hypertension management  Payment system  Integrated evidence informed policy making  Conclusion

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6 Japanese new insurance coverage for H. pylori eradication The Japanese Society for Helicobacter Research published a guideline recommending that all H. pylori-infected people receive bacterial eradication therapy. In response to this, the Japanese government has expanded coverage by the national health insurance scheme. Int J Cancer. 2013 Mar 15;132(6):1272-6. doi: 10.1002/ijc.27965. A new approach for elimination of gastric cancer deaths in Japan. Asaka M.

7  Not necessarily  Depends on the incidence of disease  Cost effectiveness ratio  Available resources  Other factors

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9  Before Policy:  80% of patients used Herceptine  20 % of costs could be covered by insurance  After Policy  20% of patients will use Herceptine  80% of costs could be covered by insurance

10 +18.5% + 25. 3 %

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13  PET Scan is not suitable for screening or diagnosis  Appropriate for Staging /follow up of some cancers  NSCLC  Lymphoma  Head and neck  ….

14 femaleprimary siteASRmaleprimary siteASRTotal 1breast23.161skin19.15 14808.5 2skin13.162stomach14.9 9821 3colon & rectum7.43bladde11.3 6545 4stomach6.744prostate9.22 5586 5esophagus6.125colon & rectum8.02 4949 6Hematologic3.686esophagus5.71 3286.5 7thyroid3.477Hematologic5.36 3090.5 8ovary2.988lung4.63 2663.5 9bladder2.869lymph node3.67 2285.5 10corpus uteri2.4510larynx2.98 1900.5 11lymph node2.2611brain & cns2.46 1652 12Lung2.0412kidney2.08 1442 Total 58030 Cancer rate per 100000 in Iran Then how many PET Scan do we need in Iran?

15 Table 1:Number (%) of patients performed MRI according to their Indications and contraindications ContraindicationTotal -+ Indication + 187 (46.7%) 18 (4.5%) 205 (51.2%) - 186 (46.5%) 9 (2.3%) 195 (48.8%) Total373 (93.2%) 27 (6.8%) 400 (100%) Paper in press : Sanaz zargar, Ali Akbari Sari 1*, Reza Majdzadeh 2, Arash Rashidian 1,Mohammad Arab 1 and Hojjat Rahmani 3

16  37% of patients with MHT that underwent CT scan in emergency departments had no indication for CT scan.  86.5% of CT results were normal. Iran J Prev Med, in press (May 2014) Sanaz zargar, Ali Akbari Sari 1*, Reza Majdzadeh 2, Arash Rashidian 1,Mohammad Arab 1 and Hojjat Rahmani 3

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19 19 Treatment effects for hypertensive individuals (mmHg) RuralUrban Treatment effects for diabetics (mmol/L) RuralUrban

20  500 to 1000 reported cases per year, no report of death  Additional cost of about 100.000 US$ for one more case prevented  ITN more cost-effective

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22  Mammography for Breast Cancer  CT coronary angiography for CAD

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24 Ref. :Adapted from Busse R et al. Intern J Technol Assessment Health Care 2002; 18(2): 361-422 Evidence-based Medicine (EBM) Clinical Practice Guidelines (CPGs) Health Technology Assessment (HTA)

25 Science Decision-Making Evidence for Best Practices

26  Use global evidence: KTE, …  Provide mew evidence  Primary studies, SR, EE, …  HTA  KM (Clinical guidelines, protocols, …)  Registry / surveillance system  Payment system  Control and monitoring  Other programs: dual practice, family physician, … Then provide financial resources dominantly via NHIS, NHS or a combination of them This is perhaps the only Path to Iran UHC

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