Health-related quality of life and disease burden of psoriasis in Iran

Kivonat, rövid leírás

The concept of health has dynamically been changing by rise of new needs and diversity in human preferences. Also by improvement of life expectancy from the beginning of 20th century, the concept of health for the person and the society has evolved. Advancements in science and technology has made this possible and has changed human needs. For example, fear of dying has changed to dedication to survival and living healthier for a longer time. Longer life expectancy leads to larger population of elderly people with higher chance of chronic health problems. Economic evaluation is vital, to make value for money when utilizing resources and achieve higher efficiency and effectiveness in decision-making. In order to avoid unfeasible and suboptimal decisions, a careful analysis of all aspects including costs and consequences is needed. Decision-making that are based on preferences for health states, along with the economic analysis focused on the patient's and societal perspective, can improve the distribution of finite resources in the face of a growing and increasingly challenging demand. New innovative health technologies are developed, often very effective but rather costly. The fourth hurdle, i.e., requirement of effectiveness and cost-effectiveness data for drug coverage policy decisions, became highly relevant even in economically developed countries. (Gulacsi et al., 2004). Health technology assessment (HTA) is now an established input to healthcare decision-making and has been introduced in many countries. HTA involves health economic evaluation that requires input data considering local aspects such as characteristics of the health care system, clinical practice, patients’ characteristics, individual and societal preferences in a given country. Transferability of international results is often limited due to differences between countries and regions (costs differ, health states might differ, cultural differences might affect people’s preferences), therefore economic evaluation conducted in one setting might not be applicable 13 to another and as a consequence, country-specific evaluations are needed that reflect the needs of the decision-makers in that country. HTA has been introduced in Iran, however country-specific input data both on health-related quality of life (HRQOL) and cost data for health economic evaluation are often missing. The main aims of the studies of this thesis are the following: - to explore notions of health among the general public as it may have implications for HRQOL assessments and decision making in healthcare, including both medical and resource allocation decisions - to investigate HRQOL and cost-of-illness in a specific patient population, namely psoriasis and analyse the inter-country differences. In the first part of the thesis followed this introduction (Chapter 1 Introduction), the key terms related to the empirical researches are described (Chapter 2 Key terms and definitions of the thesis). Afterwards, a description of the Iranian health care system is provided (Chapter 3 Iranian health system) as well as a policy analysis of the development of the Iranian HTA based on extensive literature review (Chapter 4 Health policy and health technology assessment in Iran). The focus of the empirical research of this thesis is on HRQOL, i.e. how individuals or a group perceive physical and mental health and social well-being over time. This subjective perception can be influenced by several factors, including their beliefs, subjective expectations, previous experiences, cultural and religious attitudes, personality-related factors. Moreover, it can vary individually or regionally. The first empirical study of this thesis (Chapter 5: An empirical investigation into the concept of health) aimed to explore people’s perception on health, which aspects of health are the most relevant for the individuals. It can have implications on HRQOL research and preference measurement. 14 The second empirical study (Chapter 6: Health-related quality of life and cost-of-illness of psoriasis patients in Iran) involved a cross-sectional survey in Iran among patients with a chronic dermatological disease, namely psoriasis. This study was part of a psoriasis research project leaded by researchers at Corvinus University; most of it was conducted in Hungary. Psoriasis is of high interest due to its prevalence, impact on patients’ HRQOL and, from the economic point of view, due to the costly biological drugs. Biological drugs have speeded up HRQOL and cost-of-illness (COI) research in psoriasis in many countries – measure health outcomes considering patients’ preferences (HRQOL measurement), cost-effectiveness, budget impact issues and affordability. The aims of the study were on the one hand, to assess patients HRQOL and to assess the relationship between disease-specific and generic HRQOL measures in order to provide local data for health economic analyses, to compare the results with other countries and thus provide a basis for transferability analyses. On the other hand, and I find it equally important, this experiment can serve also as useful test how brief cross-sectional surveys developed in a European country (namely in Hungary) can be applied in and adapted to Iran in terms of feasibility and applicability in order to obtain comparable data in the context of limited research resources and to strengthen international collaboration. The results of the thesis clearly show the usefulness and increasing importance of health economics in health policy and financial decision making. Finally, all the results and policy implications are discussed in the last chapter (Chapter 7 Summary).