Ali Akbari Sari, MD, PGC, PhD Dean of School & Associate Professor School of Public Health Tehran University of Medical Sciences firstname.lastname@example.org 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
School of Public Health Tehran University of Medical Sciences
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
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.
Not necessarily Depends on the incidence of disease Cost effectiveness ratio Available resources Other factors
PET Scan is not suitable for screening or diagnosis Appropriate for Staging /follow up of some cancers NSCLC Lymphoma Head and neck ….
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?
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
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
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)
Science Decision-Making Evidence for Best Practices
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