Cost-effectiveness analysis of tele-retinopathy of prematurity screening in Iran

AIM:To conduct a cost-utility analysis of the teleretinopathy of prematurity(ROP)screening program against no screening.METHODS:A decision tree model was developed to identify and treat the infants with threshold ROP through the tele-screening system compared with no screening program from the societal perspective.We used the quality adjusted life years(QALY)index to measure the scenarios’effectiveness,which was discounted for the future years by 0.058.One hundred twenty-six randomly selected newborns with ROP required treatment were investigated to extract the treatment information.We considered the direct medical and non-medical costs in cost calculations analysed by the bottom-up approach.The figures of the model’s inputs were calculated using the Monte Carlo simulation that generated 1000 random iteration of the data,and a one-way sensitivity analysis was performed on the model to cope with the potential uncertainties.RESULTS:The total and per capita needed the budget to establish a tele-ROP screening system were estimated at over 1.5 million and 35.13 USD,respectively.The total cost of identifying and treating an ROP case in tele-screening and no screening strategies were obtained as 108.72 and 63.52 USD,respectively,and their lifetime discounted QALY gained were calculated as 15.39 and 15.11,respectively.Therefore,incremental cost-effectiveness ratio(ICER)of tele-screening strategy against the competitive strategy was achieved as 161.43 USD.CONCLUSION:Tele-ROP screening program is one of the most cost-effective interventions in the Iranian health system and has a high priority to receive a budget for implementation.

The trade-off between COVID-19 and mental diseases burden during a lockdown: Mathematical modeling of control measures

Background:During the COVID-19 pandemic,many countries used lockdowns as a containment measure.While lockdowns successfully contributed to slowing down the contagion,the related mobility restrictions were reportedly associated with an increased risk of major depressive and anxiety disorders.We aimed to quantify the trade-off between the quality-adjusted life years(QALY)gain due to lower COVID-19 incidence as a result of a lockdown and QALY loss due to lockdown-induced mental disorders.Methods:We developed an agent-based model of COVID-19 epidemic and coupled mental disorder development in the population of a large city.We used data sources on the places of living,studying and working,public health and census surveys.Modeling of mental disorders was based on diathesis-stress concept.We quantified mental and physical health burden in terms of QALY taking into account major depressive and anxiety disorder episodes,lethal and non-lethal cases of COVID-19,and immunization.Findings:We evaluated the dynamics of new major depressive disorder(MDD)and anxiety disorder(AD)cases during the period between September 2020 and December 2021 in Moscow,Russia.We found that lockdown imposition increases the daily chances of getting MDD or ADD by a vulnerable person by 16.79%(95%CI[12.36%,21.23%]).The QALY loss associated with COVID-19-induced and lockdown-induced mental disorders was estimated to be 18.93%(95%CI[16.94%,19.73%])of the total QALY loss caused by COVID-19,immunization,and all kinds of mental disorders.For a synthetic“strong”lockdown,it had been shown that QALY loss is minimized when about 70%of the population are isolated.Interpretation:The burden associated with mental disorders amounts to a considerable part of COVID-19-related losses.Our findings demonstrate that cost-benefit analysis of mobility restriction should include a forecast of mental disorder development in the population.