Health Technology Assessment in Action

How to Manage the Conflict of Interests in Health System Payment Methods? A Mixed-Method Study in Iran

Tue, 19 May 2026 06:08:24 +0000

Introduction: Efficient payment systems are vital for reducing health system costs while improving service quality. This study aimed to examine how to manage the conflict of interests in payment methods and propose payment recommendations for the health system staff in Iran.

Methods: This mixed-method study was conducted at Tabriz University of Medical Sciences (2023) using a scoping review, semi-structured interviews, and Delphi method. The scoping review followed the Arksey and O’Malley protocol. Experts were interviewed to adapt global evidence to Iran. Thematic analysis was used to generate and evaluate policy options for managing the conflict of interests in health system payment methods. Moreover, the Delphi process and analytic hierarchy process prioritized these options based on effectiveness, feasibility, economic efficiency, and budget requirements.

Results: Overall, 1,031 articles were initially identified, with 22 meeting the inclusion criteria after a rigorous selection process. Three policy options were evaluated, including modified per capita with pay for performance (MPCP4P), modified salary with P4P, and modified fee for service with P4P. MPCP4P emerged as the top choice due to its superior economic benefits and effectiveness. It was revealed that MPCP4P mitigates financial risks for providers while ensuring high-quality care, making it the most suitable option for the country’s payment system.

Conclusion: The MPCP4P method, with risk adjustment and quality indicators, reduced conflicts and service reduction in capitation systems. The implementation solution includes determining quality and performance indicators, establishing a risk adjustment framework, and managing referrals. Rigorous oversight and continuous evaluation are also essential.

Calculating the Costs of the Technical Component of Operating Room in Selected Hospitals in Iran, 2019

Tue, 19 May 2026 06:23:42 +0000

Introduction: Considering that surgeries have a significant role in treating and improving patients’ health, increasing the efficiencyand optimizing the costs in the operating rooms are highly important. Thus, this study aimed to calculate the costs relatedto the technical component of the operating rooms in selected hospitals affiliated to Tehran and Iran Universities of MedicalSciences in 2019.

Methods: This research is a retrospective, descriptive, and analytical study, which is considered applied in terms of its objective.First, literature reviews and expert panel discussions were held, and calculating the methods and assumptions was defined, followedby performing a quantitative study and using traditional costing methods. Data were collected from forms, hospital documents,and the hospital information system and then recorded in Excel 2016. After performing calculations, cost analysis was conductedin two scenarios.

Results: In all the operating rooms of Tehran and Iran Universities of Medical Sciences, considering depreciation, the highest andlowest unit costs of the technical component were $3.54 and $1.68 based on USD purchasing power parity, respectively. Bothvalues exceeded the technical component rate of $0.87 in 2019,, demonstrating a negative cost-to-revenue balance in all operatingrooms. Even without considering depreciation, the unit cost of the technical component in all operating rooms (except one) washigher than the monetary coefficient of the technical component of $0.87 in 2019.

Conclusion: The significant difference between the unit cost of the technical component in the operating room and the technicalcomponent rate in 2019 led to increased costs for hospitals. Given the increasing trend of consumable costs, this cost imbalance islikely to widen further. Hospitals are forced to use their own revenues to cover these costs since they are not covered by insuranceorganizations or patients. Therefore, it is essential to take necessary measures to adjust the percentage of the technical componentof the operating room and adopt policies to prevent problems in the continuity of service delivery in public hospitals.

A Comparative Analysis of Surgery and Radiofrequency Therapy for Urinary Incontinence in Iranian Women: Health-Related Quality of Life Improvements and Short- Term Cost-Utility Analyses

Tue, 19 May 2026 09:15:11 +0000

Introduction: This study evaluated the health-related quality of life (HRQOL) outcomes and the short-term cost-utility of surgery versus radiofrequency (RF) in treating urinary incontinence (UI) among Iranian women.

Methods: This prospective non-randomized cohort study with economic evaluation assessed the cost-utility of surgery versus RF from the Iranian health system’s perspective. HRQOL was measured using the EuroQol five-dimensional five-level (EQ-5D-5L) and PRAFAB Urinary Incontinence questionnaires, with data collected from 79 women with UI before and three months after the intervention. Costs were calculated based on hospital records. The final outcome was the quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) was calculated.

Results: The study sample had an average age of 51.43 years. Surgical intervention led to a significant improvement in HRQOL, with a mean utility increase from 0.21 to 0.70 and a decrease in PRAFAB incontinence severity scores. RF treatment also improved HRQOL, with utility increasing from 0.50 to 0.86. Moreover, the mean cost of surgery was USD2,200, significantly higher than that of RF, which was USD 622.52. The ICER for surgery compared to RF was USD12,724.93, indicating that surgery is cost-effective.

Conclusion: Surgery and RF both improve HRQOL, with surgery offering a greater QALY gain at a higher cost. Overall, surgery is a cost-effective treatment option compared to RF, supporting its inclusion in treatment guidelines.

Socioeconomic Disparities in Oral Health Practices: Insights From a Cohort Study in Southwestern Iran

Tue, 19 May 2026 09:23:00 +0000

Introduction: Iran faces a high burden of oral disease loads, including decay, gum issues, and loss, prevalent across all age groups.The present investigation explored disparities related to socioeconomic factors in oral health practices among adults aged 35–70years from the Hoveyzeh cohort in Iran.

Methods: This cross-sectional analysis was conducted within a population framework and included 10,009 individuals fromthe Hoveyzeh Cohort Study (HCS). Information was gathered on demographic characteristics, economic status, and oral healthroutines. In addition, living conditions were evaluated using a wealth index derived from household possessions, with favorableoral health defined as tooth brushing at least twice a day. Moreover, inequality in socioeconomic terms was quantified throughthe concentration index (CI), while a decomposition method pinpointed underlying elements. Finally, the statistical analysis wasconducted using Stata 14.

Results: Participants averaged 48.76 years in age, comprising 59.78% females and 87.52% married. Urban dwellers predominatedat 70%, with 20.87% and 1.97% reporting tobacco use and alcohol intake, respectively. Favorable oral health practices remainedscarce, as merely 12.87% engaged in recommended routines, 4.87% utilized rinses, and 2.73% employed floss. The CI of 0.180signaled superior practices among affluent groups. The key drivers of disparity included economic position (42.9%), living location(27.6%), schooling attainment (38.16%), and chronological age (4.50%).

Conclusion: The findings underscore suboptimal oral health routines, notably in less privileged strata, advocating for strengthenedinitiatives in prevention and learning to elevate outcomes in deprived zones.

Prioritizing Competencies of Nurses by a New Fuzzy Method: A Case Study on Hospital Emergency Wards

Jahanara Mamikhani, Shahram Tofighi, Yasaman Alikhani — Tue, 19 May 2026 09:27:24 +0000

Introduction: Core nursing competencies refer to the effective application of a person’s combination of knowledge, skills, and judgment in job. This study aimed to determine the essential competencies of nurses working in hospital emergency wards, considering the characteristics of the emergency workplace, using a new approach.

Methods: A mixed-method study was conducted in 2023. Twenty-two experts were organized into two groups of five and two groups of six. Then, qualitative approaches were employed to collect data. Group brainstorming sessions identified the list of essential competencies and characteristics of the emergency workplace, while focus group discussions were used to finalize them. Ultimately, a fuzzy pairwise comparison matrix was applied using MATLAB 23.1 to weight and prioritize the competencies.

Results: Eleven key items emerged as the main characteristics of the workplace, while thirteen were identified as the essential competencies of nurses in the emergency ward. The “unpredictability of clients” and “high levels of team discipline and autonomy” were rated as the most important workplace features. In terms of nursing competencies, “high scientific abilities and skill capacities in managing diverse care situations from infancy to elderly” also received the highest score. When incorporating the workplace characteristics into the evaluation, “speed of action, professionalism, and coordination” notably ascended to the top rank, while “responsibility” dropped to fourth.

Conclusion: The characteristics of the workplace represented a more realistic rank of nurses’ competencies. Accordingly, emergency department nurse staff should be selected and evaluated based on competencies adapted to the characteristics of the workplace

Enhancing Transparency in the Public Pharmaceutical Sector to Reduce Corruption While Increasing Trust: A Policy Brief for a Developing Country

Yasaman Herandi, Hossein Bouzarjomehri — Tue, 19 May 2026 09:33:41 +0000

Transparency plays a pivotal role in good governance and is a key tool for achieving it. As the pharmaceutical sector is considered a critical component of the health governance framework, evaluating its performance and providing policy recommendations can remarkably contribute to this goal. Therefore, a policy brief was prepared using qualitative data from our previous study that evaluated transparency in Iran’s pharmaceutical regulatory sector. Twenty-one semi-structured interviews were conducted in the mentioned study between November 2016 and July 2017, and its quantitative results have been published previously. To update the data, current laws and regulations were also reviewed to understand the context in 2024. In addition, the main findings and suggestions of Esfandiari et al (2021)were meticulously reviewed to help improve the recommendations. The policy recommendations derived from the interviewees’ discussions confirmed the necessity of creating and implement more transparent guidelines, enhancing accountability mechanisms, mandating the transparency of clinical trials, establishing evidence-based selection processes, and implementing transparent procurement systems.

Developing a National Accreditation Model for Cardiac- Pulmonary Rehabilitation Centers in Iran

Tue, 19 May 2026 09:42:27 +0000

Introduction: Accreditation has become more prevalent across different health system sectors, as it aims to enhance the performance of healthcare facilities. Therefore, this study aimed to develop a national accreditation model for cardiac-pulmonary rehabilitation centers.

Methods: This mixed-method study used the literature review, the Delphi technique, and quantitative methods for benchmarking excellent related accreditation models, assessing the extracted standards and measures from excellent models based on expert’s perspective, conducting the pilot study, respectively. During the Delphi stage, 26 experts assessed the developed measures based on “importance” and “feasibility” criteria. The pilot phase of the model included self-assessment, external evaluation, and final improvement of the developed model.

Results: The accreditation models employed in the United States, France, and Egypt, as well as those utilized by hospitals, outpatient clinics, and primary care facilities in Iran, were considered reference models. Eleven functional dimensions were met based on benchmarking. The initial design of the model included 11 dimensions, 35 standards, and 263 measures. After eliminating 18 measures and adjusting to 34 others, the final number totaled 245. The mean scores of assessed measures in importance and feasibility criteria were 8.23 and 8.11, respectively. Subsequently, the essential components of the model were identified and developed. The performance score of the assessed rehabilitation center in compliance with standards was estimated at 0.73 and 0.23 in the self-assessment and external survey phase of the pilot study.

Conclusion: Given the model’s comprehensiveness and the endorsement it has received from experts and stakeholders, its implementation is anticipated to establish a solid basis for the ongoing enhancement of cardiac-pulmonary rehabilitation centers’ performance.