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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 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 Mar 15;132(6): doi: /ijc 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% %

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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 1breast23.161skin skin13.162stomach colon & rectum7.43bladde stomach6.744prostate esophagus6.125colon & rectum Hematologic3.686esophagus thyroid3.477Hematologic ovary2.988lung bladder2.869lymph node corpus uteri2.4510larynx lymph node2.2611brain & cns Lung2.0412kidney Total Cancer rate per 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 (46.7%) 18 (4.5%) 205 (51.2%) (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 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): 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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