Showing 16 results for Screening
Keihani Md, Nakhjavani M,
Volume 59, Issue 1 (4-2001)
Abstract
The diabetes is an autoimmune disease, in which the role of autoantibodies is of a specific importance. The appearance of these autoantibodies can be the first symptom in the serum of type I diabetic patients, which may appear ten years before onset of the disease. The most important autoantibodies include Glutamic acid decarboxylase autoantibodies (GAD65-Ab). This can be used as a good tool for prediction in screening tests in type I diabetic patients. In the present study with prosedure RIA, we investigated the level of GAD65-Ab in patients with diabetes type I and their close relatives, and compared them with healthy persons. From the type I diabetic patients who have been suffering from the disease for periods of one week to twenty years, 63.3% of them had positive Anti-GAD65. This ratio was 8% in their close trelatives, and 0% in healthy persons. The difference in Anti-GAD65 between the healthy persons and close relative of patients was significant. This test may be employed in diabetes type I, as a screening test, and confirms the results of studies which have been conducted so far outside this country.
Garshasbi A, Faghihzadeh S, Falah N, Khosniat M, Torkestani F, Ghavam M, Abasian M,
Volume 67, Issue 4 (7-2009)
Abstract
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Background: Gestational diabetes mellitus is diagnosed as carbohydrate in tolerance demonstrated
for the first time in the course of pregnancy. The aim of this study was to evaluate
the selective screening method for gestational diabetes mellitus (GDM)
based on: 1- recommendation of
the fourth workshop- conference on GDM 2-
evaluation of risk factors
Methods: A case-
control study was performed on 370 pregnancies inflicted
by GDM in Hazrat
Zaynab
Hospital,
Shahed
University.
The maternal and perinatal outcomes and prevalence of risk factors based on recommendation
of the fourth workshop- conference on GDM
in these women with GDM were compared with the
same data and risk factors of randomly selected 600
pregnant women at the same time and in the same hospital, they all underwent
universal testing for GDM, and their OGTT
were normal.
Results: The prevalence of all risk factors was significantly higher in the group with GDM,
but 45 of these women (12%)
had no risk factors. 107 women (29%)
with GDM were at low risk and would remain undiagnosed
if selective screening method was used. The
main neonatal complications in the low- risk group did not differ from the
complications in other women with GDM.
Conclusions: The
universal screening of all pregnant women seems to justified whereas the
recommendations for not screening low- risk group are doubtful and require further
examination.
Ali Zamani, Alireza Karimi, Mohsen Naseri, Elaheh Amini, Mohammad Milani, Amir Arvin Sazgar, Seyed Mousa Sadr Hosseini, Mohammad Sadeghi Hassan Abadi, Fatemeh Nayeri, Firouzeh Nili, Mamak Shariat, Mostafa Vasigh, Fariba Nasaj, Fatemeh Zamani, Narges Zamani,
Volume 68, Issue 1 (4-2010)
Abstract
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Background: American pediatric Association proposes to
screen all neonates with Oto-Acoustic Emission (OAE). In developing countries, because of several limitations,
health policy makers recommend to screen only in high risk patients. This study is performed with the aim to screen
hearing loss in 950 high risk newborns hospitalized in hospitals
affiliated to Tehran University using the OAE test.
Methods: A total of 950 neonates hospitalized in the Neonatal and NICU wards of
Vali-e-Asr, Shariati, Medical Center and Bahrami Hospitals during the years 2004-2006 who
showed at least one risk factor using TEOAE hearing test were enrolled into this cross-sectional
descriptive analytical study and were diagnosed with mild deafness and total
deafness. Blood exchange due to hyperbillirubinemia, septicemia, congenital
heart disease, the fifth minute apgar scores below six, PROM more than six hours, epilepsia, need to NICU more than five hours, pneumonia and Oto-Toxic drugs
were considered as risk factors. Data was past medical history, current
disease, admission cause, sign & symptoms and complications of disease.
Results: Multivariate logistic regression and paired t-test
showed that blood exchange, low birth weight and low first minute Apgar scores
had the highest independent risk for hearing loss among newborn.
Conclusion: Despite of the low prevalence of neonatal hearing loss,
screening of hearing loss at early stages is important.
Mirsharifi R, Zhand N, Shahriyarian Sh, Meysamie A, Mirsharifi A, Aminian A,
Volume 69, Issue 5 (8-2011)
Abstract
Background: Prevalence of Abdominal Aortic Aneurysm (AAA), estimated by various studies, ranged from 4.1% to 14.2% in men older than 60 years. Most cases of AAA are asymptomatic and often discovered incidentally. Approximately the initial presentation in 12% of cases of AAA is sudden rupture with subsequent high mortality. This study was performed to evaluate the prevalence and screening necessity of AAA among Iranian men older than 65 years old.
Methods: In this cross-sectional study, men older than 65 years, who referred for ultrasound examination to three different centers in Tehran, Iran at the year 2008 were included for evaluation of size of the abdominal aorta and presence of AAA.
Results: A total of 240 men older than 65 years enrolled in this study. AAA was found in 24 of the participants with prevalence rate of 10% in the studied population. Mean diameter of detected aneurysms was 3.931.435 cm. In 4 (1.7%) subjects, aneurysms greater than 5.5 cm in diameter were detected. One of these four subjects had the history of coronary artery disease and one was cigarette smoker. Three out of four had history of hypertension.
Conclusion: Considering the estimated prevalence rate of AAA by the current study and the population of Iranian men older than 65, implementing of mass screening for AAA in this group would detect 986 asymptomatic cases each year. Therefore, the authors recommend further studies about the cost-effectiveness of mass screening for AAA among Iranian men above 65 years.
Jafari S, Khaleghi S, Basi A, Ramim T,
Volume 70, Issue 2 (5-2012)
Abstract
Background: Patients with endometrial or ovarian cancer have an increased risk for breast or colon cancer. The aim of this study was to assess the individual and age-related characteristics of patients with a combination of these malignancies.
Methods: In this retrospective descriptive study, we reviewed the medical records of 100 patients admitted for endometrial or ovarian cancer in Rasol Akram, Akbarabadi and Firozgar educational Hospitals in Tehran, Iran, during 2010- 2011. Colon polyps were evaluated by immunohistochemistry assay.
Results: The mean age, weight and BMI of the patients were 50.21, 65.9 and 26.07, respectively. Among 100 cases participating in this study, five (5%) patients had colon polyps. All the five cases with colon polyp had positive familial histories of ovarian cancer.
Conclusion: With considering the low prevalence of colorectal polyps among women with ovarian and endometrial cancers, patient's follow-up for screening test is not recommended.
Sajedi F, Vameghi R, Kraskian Mojembari A, Habibollahi A, Lornejad H, Delavar B,
Volume 70, Issue 7 (10-2012)
Abstract
Background: The aim of this study was to provide a valid Persian version of the Ages and Stages Questionnaires, in order to compensate the lack of developmental screening tools in Iran.
Methods: Forward and backward translation, face and content validity determination, and cultural and linguistic adaptation of the questionnaires were performed, consecutively. Next, a pilot study was carried out on 100 Iranian parents of 4- to 60-month-old children, recruited by consecutive sampling in Tehran, Iran during the year 2006 to determine the degree of clarity for each item and explore cultural adaptations. In order to determine inter-rater reliability, we had parents of 38 children complete the questionnaires. For determining the psychometric properties of the tests, we later recruited a representative sample of 555, 4- to 6-year-old children by consecutive sampling from health care centers in five main geographical areas in Tehran.
Results: Performing cultural and lingual adaptations, our expert team made some inevitable changes to the questionnaires. Almost in all age groups older than 10 months, cultural or linguistic changes were made in items in the “communication” domain. Overall, the questionnaires’ Cronbach alpha was 0.79. The constructive validity of the tests was also satisfactory. Another important finding was determination of the children’s developmental mean scores.
Conclusion: The culturally adapted Persian copies of the Ages and Stages Questionnai-res have proper validity and reliability for being used as developmental screening tools for children in Tehran.
Rashidi-Nezhad A, Fakhri L, Hantoush Zadeh S, Amini E, Sajjadian N, Hossein Zadeh P, Niknam Oskouei F, Akrami Sm,
Volume 70, Issue 10 (1-2013)
Abstract
Background: Neonatal deaths stand for almost two-thirds of all deaths occurring in infants under one year of age. Congenital anomalies are responsible for 24.5% of these cases forming a highly important issue for health policy-makers.
Methods: We studied the pre-, peri- and post-natal conditions of 77 patients with multiple congenital anomalies (MCA) through genetic counseling at Several university Hospitals, in Tehran, Iran. The collected data were subsequently analyzed using SPSS software.
Results: The patients did not have a good prognosis, demonstrating the need for the diagnosis of such diseases early in pregnancy to be of utmost importance. We screened for trisomy and nuchal translucency, which the first showed a low risk and the second showed normal results in most cases.
Conclusion: Establishment of standards for prenatal diagnosis of congenital anomalies and monitoring their implementation seem to be necessary for the reduction of deaths due to congenital anomalies and infant mortality rate (IMR).
Samileh Noorbakhsh , Majid Kalani , Ali Mohamad Aliakbari , Azardokht Tabatabaei , Fahimeh Ehsanipour , Reza Taghipour , Mohamad Reza Shokrolahi ,
Volume 71, Issue 6 (9-2013)
Abstract
Background: The incidence and clinical presentation of congenital toxoplasmosis in our newborns was not studied until yet. Goal of study is to evaluates the newborns for congenital Toxoplasma.Gondii infection and describe the clinical presentation from birth and follow up them.
Methods: We conducted a prospective study upon 270 newborns were born in two university hospitals in Tehran (Rasoul akram & Akbar Abadi) during 2011-2012. Cord blood sample obtained from the newborns during labour. The samples centrifuged, transported and restored in -80 centigrade freezer in our Research Laboratory. Specific T.Gondii- antibodies (IGG, IGM) evaluated by ELISA methods. Neonates with positive T.Gondii- IGM diagnosed and studied as infected cases. The infected cases treated and followed for progression of disease.
Results: Gestational age of newborns was between 28-41 weeks. Positive T.Gondii -IGM and T.Gondii -IGG determined in 1.5%, 44.1% of cases respectively. The most common clinical presentation in seropositive cases was eye involvement (50%), and brain disorders (50%). Positive PCR had not found in cerebrospinal fluids of seropositive (IgM) cases.
Conclusion: One and a half percent of newborns were seropositive for T.Gondii. Wide variation of clinical presentation and early diagnosis of infected newborns in our country is so important. Adding the serologic tests (IGM) to neonatal screening test is recommended strongly.
Razieh Mohamad Jafari, Mehrnaz Taghvai Maasomi , Mahin Najafian , Najmie Saadati ,
Volume 72, Issue 7 (10-2014)
Abstract
Background: Previous investigations have shown that pregnancy-associated plasma protein-A (PAPP-A) levels are associated with adverse pregnancy outcomes including intrauterine growth restriction (IUGR) fetuses as well as preterm delivery. The aim of this study was to determine the rate of preterm delivery in women with low PAPP-A and at intermediate risk for chromosomal abnormalities in the first trimester screening.
Methods: A total of 137 women who underwent Down syndrome screening between 11 to 14 weeks of gestation were studied from September 2011 to September 2013 at Perinatal Care Clinic, Imam Khomeini Hospital, Ahvaz, Iran. From those, 52 patients had low PAPP-A. Inclusion criteria were singleton pregnancies, at 11 to 14 weeks of gestation, at intermediate risk for Down syndrome (risk in 1:101 to 1:1000). The intermediate risk was estimated based on maternal parameters, maternal serum markers (PAPP-A and β-hcG), and nuchal translucency (NT) using fetal medicine foundation (FMF), UK) software. The power of the study was 90%. The sample size was estimated based on prevalence of preterm delivery in pregnancies with low PAPP-A in the first trimester screening. Patients were followed-up until delivery to observe pregnancy outcomes. We evaluated the variables such as level of PAPP-A, outcomes of delivery, age, β-hCG, and gestational age.
Results: Among 137 normotensive pregnant women at intermediate risk for Down syndrome, 52 cases (38%) had low PAPP-A (<0.4 MoM). Of 52, 14 cases (27%) had preterm delivery. None of our patients had pregnancy related or non related diabetes, preeclampsia, or chromosomal anomalies. 45 cases (86%) from 52 patients were equal or less than 35 years, while 7 patients were more than 35 years. Among 52 followed-up patients, 48 patients (92.4%) were at low-intermediate risk (risk in 1:251 to 1:1000), and 4 cases (7.6%) were at high-intermediate risk (risk in 1:101 to 1:250).
Conclusion: We found high frequency of preterm delivery in pregnant women with low PAPP-A level at the first trimester screening. Hence, this group of patients needs special and early preventive management. Furthermore, we suggest that future researches to be conducted with larger sample size and also cervix length measurement to be included.
Alireza Ebrahimi , Zohre Niknami , Fahime Nazari , Mahasti Ghavami Adel , Amir Atashi , Abdolfattah Sarrafnejad ,
Volume 74, Issue 3 (6-2016)
Abstract
Hemoglobinopathies are most common inherited disorders in the world; approximately 7 percent of the worldwide population and 5-6 percent of population of Iran are carriers. The hemoglobin disorders inherit as autosomal recessive and are very common in the Mediterranean area and much of the Asia and Africa. The control of this inherited disorders need to genetic counseling and accurate screening by more advanced and more accurate methods. This study explains features of current Iran hemoglobin disorders, nominates the accessible methods for screening them and introduces the capillary zone electrophoresis as a rapid and more accurate method. The required data were extracted of various articles and then for good explanation, current Iran hemoglobinopathies properties were showed in the tables and electropherograms of important hemoglobin disorders in Iran population were provided for help to interpretation results of blood tests by capillary zone electrophoresis method. Hemoglobin disorders are including thalassemias and hemoglobin variants; Disruption in the production and malfunction of globin chains cause types of hemoglobin disorders. We cannot introduce one of clinical laboratory tests as critical and basic method for screening and distinguishing types of inherited hemoglobin disorders as alone. For distinguishing the types of them must be prepared enough information and data of the hemoglobin disorders and for more accurate analysis must be used simultaneously different methods as gel electrophoresis, high performance liquid chromatography, isoelectric focusing, capillary zone electrophoresis or molecular tests. The capillary electrophoresis is an accurate and rapid method for screening types of the hemoglobin disorders. Other side this method cannot analyze all of them, so must be used biochemical, biophysical and molecular methods for confirmation the results. This review showed we can use the capillary electrophoresis and HPLC as two complementary methods for hemoglobinopathies screening. We can analyze by the methods more hemoglobin disorders and decrease more laboratory errors. Moreover, we must have patient history, hematological indices, information and data of types of hemoglobinopathies. The patient history and complete blood count results as red blood cell count, mean corpuscular volume, mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration can be useful and helpful in screening the hemoglobin disorders and then distinguishing all of hemoglobin disorders.
Farzad Tajdini, Reza Shekarriz-Foumani , Parinaz Rezapour , Kambiz Abachizade, Maryam Mohseni ,
Volume 76, Issue 12 (3-2019)
Abstract
Background: Using alcohol is one of the most important death factors that can be prevented. Lifestyle-related diseases are at the top cause of mortality and burden of disease, whereas most of them can be prevented. Considering the growing importance of diseases related to lifestyle (including alcohol abuse), providing evidence-based clinical guidelines for diseases and life-style related conditions which are in accordance with the newest scientific findings and with cultural and economic conditions in each country are required. The aim of this study was to develop a clinical guideline for prevention and control of alcohol consumption.
Methods: The type of study is initiation of a method or a scientific/administrative system (health system management studies) that uses the National Pattern of Localization of Clinical Guidelines in 2017 in Taleghani Hospital of Shahid Beheshti University of Medical Sciences, Tehran, Iran, by using the reviewed clinical guidelines, which was conducted by the end of 2017 based on organizational criteria, the availability of the full version of the clinical guideline and its up-to-datedness, and the appraisal of guidelines for research and evaluation (AGREE) scoring system. This clinical guideline was developed based on 5A Model (Assess, Advise, Agree, Assist and Arrange).
Results: In order to prevent and control alcohol abuse, a clinical guideline was developed based on five clinical guidelines including United States Preventive Services Task Force (USPSTF), Healthy lifestyle guideline (ICSI), the guidelines for preventive activities in general practice in Australia (RACGP), The Australian population health guide to risky behavioural risk factors in general practice (SNAP), and the guidelines related to lifestyle and wellbeing by the National Institute of Clinical Excellence of England (NICE) in the form of 5A model.
Conclusion: The best practice is according to the existing clinical guidelines for prevention and control of alcohol use screening, brief intervention (1-2 sessions) and behavioral counseling, treatment with cognitive behavioral interventions (2-6 sessions) and, if necessary, referrals to higher treatment centers. Referral is recommended for patients who have signs of substance dependence and need a level of care beyond brief service.
Zahra Aryan, Atekeh Bahadori , Dariush Farhud,
Volume 77, Issue 1 (4-2019)
Abstract
The purpose of prenatal diagnosis tests is insisting of diagnosis of neonatal disorders, preparing a range of informed choices and making couples at risk to be ready for having children with genetic disorders as well. The aim of this article is to investigate all of the tests in order to determine the best one which has the lowest risk and the highest sensitivity. Screening tests (maternal blood test and ultrasonography for first and second trimester) are testing patients without symptoms who are at low risk. These tests are carried out in the early stages of pregnancy, and the risk of genetic diseases would be estimated. They are safe and also might be helpful in determining whether invasive prenatal genetic tests including chorionic villus sampling, amniocentesis, and percutaneous umbilical blood sampling are needed. Diagnostic test is insisting of invasive tests: amniocentesis, chorionic villus sampling (CVS), cordocentesis, and preimplantation genetic diagnosis (PGD), which is a genetic test on cells removed from embryos to help select the best ones to avoid some of genetic diseases, fluorescence in situ hybridization (FISH), QF-PCR, multiplex ligation probe amplification (MLPA), next generation sequencing (NGS), comparative genomic hybridization (CGH), and non-invasive tests: ultrasound, prenatal sonography, cell free fetal DNA, triple and quadruple screen: alpha fetoprotein (AFP), human chorionic gonadotropin (hCG), unconjugated estriol (uE3), inhibin-A). These tests are intended for patients who have apparent symptoms and the results of their early stages of pregnancy have been positive. Non-invasive prenatal tests (NIPT), sometimes called noninvasive prenatal screening (NIPS), have features of both screening and diagnostic tests, but, now screening test is more considerable. Small fragments of DNA would be analyzed by this testing in which they are circulating in a pregnant woman’s blood. While most DNA is found inside a cell’s nucleus, these fragments are free-floating and not within cells, at this point, they are called cell-free DNA (cfDNA) which usually contain fewer than 200 DNA building blocks (base pairs). Non-invasive prenatal tests is more sensitive with the high degree of specify to determine trisomy 13, 18 and 21 in women who are at increased risk of having offspring with genetic disorders.
Asghar Aghamohammadi , Mohammadreza Shaghaghi , Hassan Abolhassani , Reza Yazdani , Seyed Mohsen Zahraie , Mohammad Mehdi Goya , Susan Mahmoudi , Nima Rezaei , Shohreh Shahmahmoodi ,
Volume 78, Issue 1 (4-2020)
Abstract
Primary immunodeficiency diseases (PIDs) is a diverse group of diseases, characterized by a defect in the immune system. These patients are susceptible to recurrent respiratory infections, gastrointestinal problems, autoimmune diseases, and malignancies. In most cases, patients with primary immunodeficiency disorders have genetic defects and are monogenic disorders that follow a simple Mendelian inheritance, however, some PIDs recognize a more complex polygenic origin. Overall, almost 70 to 90 percent of patients with primary immunodeficiency are undiagnosed. Given that these patients are exposing to respiratory infectious agents and some live-attenuated vaccines, thus they have a high risk to some clinical complications. The administration of oral polio vaccine in patients with PIDs especially can increase the possibility of acute flaccid paralysis. These patients will excrete the poliovirus for a long time through their feces, even though they are not paralyzed. Long-term virus proliferation in the vaccinated individuals causes a mutation in the poliovirus and creates a vaccine-derived polioviruses (VDPVs), which is a major challenge to the final stages of the worldwide eradication of polio.
To increase the diagnosis and identification of patients with immunodeficiency and carrying out a national plan for screening patients with immunodeficiency from the fecal excretion of the poliovirus, a possible polio epidemic can be prevented during post-eradication. Development of laboratory facilities in provincial and city centers, improvement of communications among physicians regarding medical consultation and establishment of referring systems for patients by national network lead to improve status of diagnosis and treatment of patients with primary immunodefiicencies. In this context, launching and activating the national network of immunodeficiency diseases is essential for improving the health of children and reducing the cost of the health system of the country. A national network of immunodeficiency can lead to increase awareness of physicians regarding primary immunodeficiency disorders, improve collaboration among physicians about genetic consultation and establish a practical referral system in Iran that results in increased diagnosis and improve treatment of patients with primary immunodeficiency disorders.
Mahboobeh Shirazi, Elham Feizabad, Nesa Rajabpoor Nikoo , Fatemeh Rahimi Sharbaf, Maedeh Rahmanzadeh,
Volume 78, Issue 11 (2-2021)
Abstract
Background: For every pregnant woman, it is possible to have a child with chromosomal abnormalities. Although this possibility is not very high, by performing screening tests and considering the mother's background factors, we can largely realize the real extent of this possibility.
Many comorbidities (like high blood pressure, diabetes, and obesity) and high-risk exposures (like alcohol consumption) seem to have an important role in the development of chromosomal abnormalities. This study aimed to determine the predictive factors of a positive first-trimester screening test in the pregnant women.
Methods: This case-control study was done on pregnant women, who were referred to Yas Hospital for their first-trimester screening tests between April 2018 and February 2020. Of those who had positive screening test results, only ones with abnormal biochemical tests, were included in the study regardless of nuchal translucency (NT) examination results and were considered as cases, and the women with normal screening test results were considered as controls.
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Results: Totally 960 pregnant women (760 controls and 200 cases) participated in the study. The mean age of the subjects was 31.07±0.17 years old with a minimum age of 17 and a maximum age of 45. The averge age of case group women was 33.57±0.40 years and this was 30.41±0.18 years in control group.
This study indicated that maternal age (P<0.001) and the number of pregnancies in the case group are significantly (P<0.001) higher than the control group. Also, having a history of miscarriage (P<0.001), having a history of infertility (P<0.001), and having hypothyroidism (P=0.030) are significantly more common in the case group. The frequency of intrauterine growth failure (P=0.003) and neonatal hospitalization (P<0.001) were also significantly higher in the case group.
Conclusion: Despite recent advances in the prenatal field, the accuracy of screening tests may still vary depending on maternal age and other existing characteristics. Hence, it seems considering the mother's background characteristics are important just the same as the screening test results.
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Fariba Hemmati, Zahra Hashemi, Negar Yazdani,
Volume 78, Issue 12 (3-2021)
Abstract
Background: Neonatal jaundice is an almost common problem among neonates that may cause complications such as kernicterus in severe cases. Since early diagnosis and proper treatment of neonatal jaundice is vital to prevent the related complications, it is necessary to check bilirubin before discharging the neonates. There are several evaluating and diagnostic methods to measure the level of bilirubin. Thus, this study aimed to compare the transcutaneous method versus measurement of serum bilirubin, using spectrophotometry for jaundice screening of full-term neonates before discharge from hospital.
Methods: This observational analytic study was conducted on six hundred neonates with birth weight more than 2000 grams and gestational age more than 35 weeks from September 2012 to March 2013 in Hafez hospital, Shiraz University of Medical Sciences. Parameters such as bilirubin level of neonates were measured and compared, using spectrophotometry and transcutaneous by Bili check with multi waves.
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Results: Six hundred neonates were enrolled in this study. The Pearson correlation test showed that there was a significant correlation between the two methods of the transcutaneous versus measurement of serum bilirubin, using spectrophotometry (r=0.63), (P>0.05). There was no significant difference between the mean of measured bilirubin, using each method in some demographic variables such as the different groups of gender (P=0.896), birth weight (P=0.419), and type of feeding in neonates (P=0.323), but it was significant in other demographic variables such as the different groups of gestational age and post-neonatal age (P<0.0001). Also, the results revealed that there was a significant correlation between two methods of the trans cutaneous versus measurement of serum bilirubin, using spectrophotometry based on demographic variables (P<0.0001).
Conclusion: In general, the bilirubin measurement using trans-cutaneous method may estimate bilirubin significantly less than the serum bilirubin measurement method, and this difference can be more obviously noticeable in infants with less gestational age and also less post-natal age.
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Ahmad Tahmasebi-Ghorrabi , Zahra Heydarifard, Behrouz Nemati, Majid Davari, Alireza Delavari, Hamideh Salimzadeh , Ali Akbari Sari ,
Volume 81, Issue 9 (12-2023)
Abstract
Background: Screening is a cost-effective method for prevention, early detection of the disease and reducing the burden of the third deadliest cancer in the world, i.e. colorectal cancer. This study aimed to analyze the cost-effectiveness of colonoscopy screening compared to sigmoidoscopy for colorectal cancer in high-risk individuals in Iran.
Methods: This economic evaluation study was conducted using the cost-effectiveness method between July 2016 and February 2017. Evaluation of the effectiveness of screening methods was done using a systematic review. Cost evaluation was also done using the costs obtained from the tariff approved by the Iranian Ministry of Health in 2015 for colonoscopy and sigmoidoscopy. Finally, the combined model of decision tree and Markov was used to evaluate the cost effectiveness. Incremental Cost Effectiveness Ratio (ICER) formula was used for cost effectiveness analysis considering the final outcome of 5-year survival of high-risk individuals. Excel and TreeAge software were used for data analysis.
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Results: The effectiveness of sigmoidoscopy and colonoscopy in increasing 5-year survival is 11 and 15.7%, respectively, and colonoscopy screening is 4.7% more than sigmoidoscopy. The cost of colonoscopy and sigmoidoscopy screening was calculated as 1000 and 19920 billion Rials, respectively. Based on cost-effectiveness analysis, the cost of treating patients in the case of screening with colonoscopy and sigmoidoscopy is lower than without screening. The ICER ratio of colonoscopy and sigmoidoscopy compared to no screening was -4/441/389/160 and -4/757/954/940 Rials respectively, and colonoscopy compared to sigmoidoscopy was -3/699/785/880 Rials, respectively. Finally, the use of colonoscopy leads to spending 3/699/785/880 Rials less in exchange for obtaining 4722 additional survivals with the prevention of colorectal cancer compared to sigmoidoscopy.
Conclusion: Screening by colonoscopy and sigmoidoscopy methods are effective in reducing the incidence and death of colorectal cancer compared to no screening. Screening by colonoscopy is a dominant option for the high-risk population in Iran. Colonoscopy screening is more cost effective compared to sigmoidoscopy. However, decisions about colorectal cancer screening and screening methods depend on local resources and personal preferences.
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