Health Technology Assessment in Action
Volume:2 Issue: 1, Apr 2018

Stroke has been considered one of the most common life-threatening neurological disease and a global health problem. It causes disability in adults and ranked as the third leading causes of human mortality worldwide.

The aim of this study was to compare the quality of life in patients with stroke in both treated and not-treated groups with recombinant tissue plasminogen activator (rt-PA).

We conducted a cohort study on 126 patients with stroke, including 42 and 84 patients treated with rt-PA and without rt-PA, respectively. We used a disease-specific questionnaire for stroke, including (SSQOL) and EQ5D. Both groups were tested for potential differences regarding socio-demographic characteristics. A multiple linear regression model was exerted to find factors that affected the different aspects of QOL of the whole samples of the patients.

The result of this study showed a significant correlation in the intensity of stroke and patients’ quality of life between two groups of patients with stroke. In other words, the severity in the patients treated with rt-PA is less than a stroke three months after a stroke, and the desirability of living in this group is higher. The results of regression models for each subscale showed that age, sex, utility, hemisphere, and NHISSS were associated with several subscales of the SSQOL; NIHSS was significantly relevant to “language”, “mobility”, “personality” “social roles” and hemisphere damaged significantly correlated with “energy”, “thinking”,” language” (P < 0.05). The patient’s utility was significantly associated with “energy”, “family roles”, “language”, “mobility”, “mood”, “personality”, “self-care”, “social roles”, “upper extremity function”, “work productivity”, and “third severity” subscales (P < 0.05).

In this study, it was seen that there are significant differences between QOL of with rt-PA and without rt-PA, but the limitation of our study was that the results may be different in other countries and even various areas in Iran.

Erectile dysfunction is a common disease that has a significant negative impact on the quality of life of individuals. Low-intensity shockwave therapy (LI-ESWT) has been considered a new method for treating patients with erectile dysfunction.

To evaluate the safety and efficacy of LI-ESWT in the treatment of patients with erectile dysfunction.

A systematic review was conducted in the major databases, including PubMed, Cochrane Library, Embase, Scopus, and Web of Science up to February 2018. In order to find more articles, the reference list of the key review articles was searched as well. The quality of the studies was evaluated with the Cochrane Collaboration’s tools. The outcomes included The International Index of Erectile Function (IIEF), Erection Hardness Score (EHS), and adverse events. Meta-analysis was performed using RevMan software, version 5.3.

Seven randomized clinical trials involving 519 patients met the inclusion criteria. A significant improvement was observed in IIEF (mean difference [MD] = 4.54, 95% CI 0.44 - 8.63) and EHS (risk ratio [RR] = 2.99, 95% CI 1.16 - 7.70) in the intervention groups compared to the control groups. Sub-analysis showed that shockwave therapy significantly improved IIEF at 6, 9, and 10 weeks after the treatment (P < 0.05), and the EHS was improved at 5, 6, and 9 weeks (P < 0.05). There was also a significant improvement in the intervention groups in IIEF and EHS for 1500 and 3000 pulses, respectively (P < 0.05). No significant side effects were reported.

The findings of this study indicate LI-ESWT improves erectile dysfunction in patients, and it is safe and well-tolerated by patients.

Lung cancer is one of the most common cancers worldwide with high mortality and short survival rate. Radiotherapy is one of the treatment modalities in patients who are non-surgery candidates or refuse surgery.

The current study aimed at evaluating the effectiveness and safety of this technique compared to similar ones for lung cancer treatment.

In order to answer the research question and find the available evidence, after the development of the search strategy, Pubmed, Cochran, Ovid, Medline, and DARE databases were searched and related articles were selected based on the inclusion criteria. Then, we chose all studies that had the PICO acceptance criteria (Participants: adults with lung cancer; Intervention: tomotherapy; Comparisons: tomotherapy with Cyberknife; Outcomes: local tumor control (LTC), survival rate (SR), complications, and degree of toxicity). The quality assessment of the studies was conducted using the CASP (Critical Appraisal Skills Programme) checklist. Two independent search engines evaluated the articles in terms of methodology, and information was extracted from the papers.

Overall, 12 retrospective studies with 616 patients were found examining the efficacy and safety of a certain technology. According to the results of the studies, the local tumor control (LTC) index varied from 63% to 100%. The two and five-year SRs were 73% and 56%, respectively. In addition, the mortality rate of patients until the completion of the treatment course was 34%, indicating the higher efficacy of tomotherapy than the efficacy of other similar techniques. The toxicity of tomotherapy was less than that of Cyberknife, which indicates its more safety.

According to the epidemiology of cancer, especially lung cancer, and due to aging of the population in Iran, and considering the higher efficacy and safety of tomotherapy in comparison with other similar technologies, i.e., Cyberknife and Gamma Knife, tomotherapy is a superior technique in the control and treatment of lung cancer although other aspects, such as cost-efficacy, should be considered.

For many years, the classical (traditional) insulin injection methods have been used. The first insulin pen was made in the 1980s. These types of pens are divided into two categories, namely analogue and vial-human. Analogue insulin pens are similar to human insulin pens in molecular structure and can lead to differences in pharmacokinetic and pharmacodynamic properties.

This was a systematic review conducted by searching Web of Science PubMed, SID, Embase, Scopus, and Magiran databases for articles published from the beginning of 2007 to June 2017. The related studies in the field of health technology and economic assessment were investigated.

Twenty studies were included; these studies indicated that there is no reason for the higher risk of rapid-acting insulin analogue pens in comparison with vial (human) and that analogue insulin pens significantly reduce the risk of hypoglycemia. Analogue insulin was compared to other existing insulins and was not found cost effectiveness (ICER: 642994$QALY), (ICER: 130865 $ QALY), (ICER: 87932$ QALY), but due to the increased quality of life and patient satisfaction compared to vial insulin pens, this type of pen has been used. Some studies have shown that aspart 30 insulin pens are more cost-effective than other analogues (ICER: 22488$QALY).

Although the use of analogue insulin is more expensive for diabetic patients, it is more effective than vial insulin. Thus, insurance companies are recommended to develop special plans for the three vulnerable groups of seniors, children, and pregnant women to provide them with analogue insulin.