Ali Akbari Sari, MD, PGC, PhD Dean of School & Associate Professor School of Public Health

2. Evidence Informed Policy Making Path to Iran Universal Health Coverage Lessons From Selected Evidence and Experiences Ali Akbari Sari, MD, PGC, PhD Dean of School & Associate Professor School of Public Health Tehran University of Medical Sciences akbarisari@tums.ac.ir 19th Apr 2014, KermanKerman University of Medical Sciences, Iran

3. School of Public Health Tehran University of Medical Sciences

4. Outlines of the session • UHC concept and dimensions • Japanese new insurance coverage for H. pylori eradication • Management of Herceptin in breast cancer • Mammography for breast cancer • PET Scan for selected cancers • MRI for low back pain • CT Scan for head trauma • CT coronary angiography for CAD • Malaria control and elimination programs • Diabetes and hypertension management • Payment system • Integrated evidence informed policy making • Conclusion

5. Three dimensions (policy choices)

6. Japanese new insurance coverage for H. pylori eradication The Japanese Society for Helicobacter Research published a guideline recommending that all H. pylori-infected people receive bacterial eradication therapy. In response to this, the Japanese government has expanded coverage by the national health insurance scheme. Int J Cancer. 2013 Mar 15;132(6):1272-6. doi: 10.1002/ijc.27965. A new approach for elimination of gastric cancer deaths in Japan. Asaka M.

7. Should we use the same policy • Not necessarily • Depends on the incidence of disease • Cost effectiveness ratio • Available resources • Other factors

9. Potential benefits of the Herceptin Policy • Before Policy: • 80% of patients used Herceptine • 20 % of costs could be covered by insurance • After Policy • 20% of patients will use Herceptine • 80% of costs could be covered by insurance

10. Annual Growth of medication Use in Iran +25.3% +18.5%

13. PET Scan is not suitable for screening or diagnosis • Appropriate for Staging /follow up of some cancers • NSCLC • Lymphoma • Head and neck • ….

14. How many PET do we need? Cancer rate per 100000 in Iran Then how many PET Scan do we need in Iran?

15. MRI for Low Back Pain Paper in press : Sanazzargar, Ali Akbari Sari1*, Reza Majdzadeh2, Arash Rashidian1 ,Mohammad Arab1 and Hojjat Rahmani3

16. CT scan For Head Trauma • 37% of patients with MHT that underwent CT scan in emergency departments had no indication for CT scan. • 86.5% of CT results were normal. • Iran J Prev Med, in press (May 2014) • Sanazzargar, Ali Akbari Sari1*, Reza Majdzadeh2, Arash Rashidian1 ,Mohammad Arab1 and Hojjat Rahmani3

19. The average effect of treatment by area of residency Treatment effects for hypertensive individuals (mmHg) Urban Rural Treatment effects for diabetics (mmol/L) Urban Rural

20. 500 to 1000 reported cases per year, no report of death • Additional cost of about 100.000 US$ for one more case prevented • ITN more cost-effective

22. Other evidence • Mammography for Breast Cancer • CT coronary angiography for CAD

23. Effective payment system at least for common procedures

24. Evidence-based Medicine (EBM) Clinical Practice Guidelines (CPGs) Health Technology Assessment (HTA) Integrated System for Best Practices Ref. : Adapted from Busse R et al. Intern J Technol Assessment Health Care 2002; 18(2): 361-422

25. Evidence for Best Practices Science Decision-Making

26. Summary: Integrated System for EVIPM • Use global evidence: KTE, … • Provide mew evidence • Primary studies, SR, EE, … • HTA • KM (Clinical guidelines, protocols, …) • Registry / surveillance system • Payment system • Control and monitoring • Other programs: dual practice, family physician, … • Then provide financial resources dominantly via NHIS, NHS or a combination of them • This is perhaps the only Path to Iran UHC

27. Thanks for your attention