Value-based Oncology in Iran: A Scoping review

Document Type : Original Article


1 Education Development Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran

2 Gastrointestinal Cancers Research Center, Mazandaran University of Medical Sciences, Sari, Iran

3 Vice Chancellery for Research and Technology, Mazandaran University of Medical Sciences, Sari, Iran

4 Research Center for Evidence-based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

5 Department of Community Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran


Introduction: Evidence synthesis about economic analysis of cancer control and management in Iran was inconsistent.
Objective: The objective of this scoping review was to examine and map the rang of studies acknowledged this issue in Iran.
Methods: Several databases such as Cochrane Library, PubMed, ProQuest، Embase، and Google Scholar have been searched with relevant search strategy. Studies published from January 1, 2000, to January 1, 2017 were examined.
Results: Finally, forty-four articles were deemed appropriate for this study and were analyzed. Twenty-three studies had performed cost analysis, twelve cost-utility analysis (CUA), eight cost-effectiveness analysis (CEA), and only one cost-minimizing analysis. In only six articles the total cost (direct and indirect) had been evaluated. The incremental cost-effectiveness ratio (ICER) index had been measured in all eight articles on CEA. In studies on CUA, only one case had considered the disability adjusted life years (DALY) index.
Conclusion: After cost analysis which is highly popular, researchers in the field of cancer economy in Iran are often interested in CEA studies and, consequently, CUA ones. Results of the present study indicate that most analyses in this field have employed appropriate methodology, leading to accurate estimations of ICER in which can be used for appropriate meta-analysis in near future.



    1. Rassuli M, Sajjadi M. The Islamic Republic of Iran. In “Cancer care in countries and societies in transition” M. Silbermann. Springer International Publishing Switzerland. 2016: 317-326.
    2. Mousavi S. Executive guideline for registering and reporting cancer cases. In “Cancer Office and the Research fellowship of Cancer Research Center of Cancer Institute: Tehran”.2007: 122.
    3. Bazyar M, Pourreza A, Harirchi I, Akbar FE, Mahmoudi M. Medical and non-medical direct costs of cancers in patients hospitalized in Imam Khomeini cancer institution-2010. J Hospital 2012; 11: 39–50.
    4. Ya-chen TS, Michael TH. Economic evaluation of medical care intervention for cancer patients: How, Why and what does it mean? CA Cancer J Clin 2008; 58: 231-244.
    5. Daroudi R, Mirzania M, Zendehdel K. Attitude of Iranian medical oncologists toward economic aspects and policy-making in relation to new cancer drugs. Int J Health Policy Manag 2016; 5: 99-105.
    6. Neumann PJ, Palmer JA, Nadler E, Fang C, Ubel P. Cancer therapy costs influence treatment: a national survey of oncologists. Health Affairs 2010; 29: 196-202.
    7. Shahabi S, Fazlalizadeh H, Stedman J, Chuang L, Shariftabrizi A, Ram R. The impact of international economic sanctions on Iranian cancer health care. Health Policy 2015; 119: 1309-1318.
    8. Sarkhanlou F, Saeedi M, Janbabai G, Nikfar S, Morteza-semnani K, Zaboli P. Comparative study of direct patient and drug costs before and after the implication of healthcare reform program in Sari, Iran. J Mazandaran Univ Med Sci 2016; 26: 228-232.
    9. Ansaripour A, Zendehdel K, Tadayon N, Sadeghi F, Uyl-de GC, Redekop WK. Use of data-mining to perform a real world cost analysis of HER2-positive breast cancer in Iran. Value Health 2016;19: A355.
    10. Foroughi moghadam MJ, Rangchian M, Ayati M, Pourmand G, Zeinali L, Rasekh HR. Economic burden of prostate cancer in Iran. Value Health 2016;19: A147.
    11. Zare F, Fattahi MR, Sepehrimanesh M, Safarpour AR. Economic burden of hepatitis C virus infection in different stages of disease: A report from southern Iran. Hepat Mon 2016; 16: e32654.
    12. Rezaei S, Sari AA. Estimating economic burden of cancer deaths attributable to smoking in Iran in 2012. J Res Health Sci 2016; 16:97.
    13. Izadi A, Sirizi MJ, Esmaeelpour S, Barouni M. Evaluating Direct Costs of Gastric Cancer Treatment in Iran - Case Study in Kerman City in 2015. Asian Pac J Cancer Prev 2016; 17:3007-3013.
    14. Karami-matin B, Najafi F, Rezaei S, Khosravi A, Soofi M. Estimating the Economic Burden of Premature Mortality Caused by Cancer in Iran: 2006-2010. Asian Pac J Cancer Prev 2016; 17:2131-2136.
    15. Sari AA, Rezaei S, Arab M, Majdzadeh R, Matin BK, Zandian H. Effects of Smoking on Cost of Hospitalization and Length of Stay among Patients with Lung Cancer in Iran: A Hospital-Based Study. Asian Pac J Cancer Prev 2016; 17:4421-4426.
    16. Ansaripour A, Zendehdel K, Uyl-de groot CA, Naemisanatdost A, Redekop WK. Direct medical costs of HER2 positive breast cancer management in Iran: A claims database and data mining analysis. Value Health 2015;18: A199-A200.
    17. Khorasani S, Rezaei S, Rashidian H, Daroudi R. Years of potential life lost and productivity costs due to premature cancer-related mortality in Iran. Asian Pac J Cancer Prev 2015; 16:1845-1850.
    18. Davari M, Yazdanpanah F, Aslani A, Hosseini M, Nazeri AR, Mokarian F. The direct medical costs of breast cancer in Iran: Analyzing the patient's level data from a cancer specific hospital in Isfahan. Int J Prev Med 2013; 4:748-754.
    19. Bazyar M, Barfar E. Cost analysis for cancer subgroups in Kerman. Iran J Epidemiol 2013; 9:69-72.
    20. Rezapour A, Ghaderi H, Ebadifardazar F, Sofla AS. Microeconomic analysis of health care services delivered to patients under urologic tumor surgeries. HealthMED 2012; 6:4141-4151.
    21. Farokhi noori MR, Holakouie NK, Haghdoost AA, Emami A. Cost analysis for cancer subgroups in Kerman, IRAN. Iran J Epidemiol 2012; 8:62-70.
    22. Mohagheghi MA, Mousavi-jarrahi Y, Mousavi-jarrahi A. Cost of care for lung cancer in the first year after diagnosis in Iran. Asian Pac J Cancer Preven 2011; 12:1013-1015.
    23. Nokiani FA, Akbari H, Rezaei M, Madami H, Agha MEA. Cost-effectiveness of pap smear in Kermanshah, Iran. Asian Pac J Cancer Preven 2008; 9:107-110.
    24. Hatam N, Keshtkar V, Salehi A, Rafei H. The financial cost of preventive and curative programs for breast cancer: a case study of women in Shiraz-Iran. Int J Health Policy Manag 2014 May; 2:187-91.
    25. Bahmei J, Rahimi H, Jafari AS, Habibyan M. Examination of medical and non-medical direct costs of outpatients and hospitalized cancer patients in Shiraz, Iran. Payesh 2015; 6: 629-637.
    26. Ghaderi H, Vatankhah S, Khoshkam M, Rohani B. Estimation of Willingness to Pay for Mammographic Breast Cancer Screening Tests among Women in Tehran, Based On Contingent Valuation Method: 2010. Journal of Health Administration 2012; 15: 32-46.
    27. Akbarzadehbaghban A, Esmaeili M, Kimiafar Kh. Medical Information Management and Assessment of Direct Costs of Treatment of Lung Cancer. Health Information Management 2008; 5:168.
    28. Davari M, Moafi A, Yarmohammadian MH, Khayyam Haghighi E. The Direct Medical Costs of Acute Lymphocytic Leukemia (ALL) In Children in Isfahan Province. Health Inf Manage 2015;11: 1057.
    29. Hayati H, Kebriaeezadeh A, Ehsani MA. Systematic Review of Treatment Costs for Pediatrics Acute Lymphoblastic Leukemia (Comparing Clinical Expenditures in Developed and Developing Countries). Int J Pediatr 2016; 4: 4033-4041
    30. Nahvijou A, Sari AA, Zendehdel K, Marnani AB. Management of precancerous cervical lesions in Iran: a cost minimizing study. Asian Pac J Cancer Prev 2014; 15:8209-8213.
    31. Ansaripour A, Uyl-de GC, Redekop WK. What is an efficient and affordable trastuzumab therapy in a middle-income country? Adjuvant therapy with trastuzumab in management of early HER2-positive breast cancer in Iran. Value Health 2016;19: A721.
    32. Davari M, Ashrafi F, Maracy M, Aslani A, Tabatabaei M. Cost-effectiveness analysis of cetuximab in treatment of metastatic colorectal cancer in Iranian pharmaceutical market. Int J Prev Med 2015; 6: 63.
    33. Barfar E, Rashidian A, Hosseini H, Nosratnejad S, Barooti E, Zendehdel K. Cost-effectiveness of mammography screening for breast cancer in a low socioeconomic group of Iranian women. Arch Iran Med 2014; 17:241-245.
    34. Moridi M, Yusef N, Pasokhi M. Cost effectiveness of human papilloma-virus testing in cervical cancer diagnosis. Int J Fertil Steril 2013; 7:152-3.
    35. Teimouri F, Nikfar S, Abdollahi M. Comparative efficacy and economic evaluation of dacarbazine and temozolomide in treatment of malignant melanoma in Iran. Value Health 2012;15: A656.
    36. Allameh Z, Davari M, Emami MH. Cost-effectiveness analysis of colorectal cancer screening methods in Iran. Arch Iran Med 2011; 14:110-114.
    37. Nassiripour L, Amirsadri M, Tabatabaeian M, Maracy MR. Cost-effectiveness of surgical excision versus Mohs micrographic surgery for nonmelanoma skin cancer: A retrospective cohort study. J Res Med Sci 2016; 21:91.
    38. Hatam N, Ahmadloo N, Vazirzadeh M, Jafari A, Askarian M. Cost-Effectiveness of Intensive Vs. Standard Follow-Up Models for Patients with Breast Cancer in Shiraz, Iran. Asian Pac J Cancer Prev 2016; 17:5309-14.
    39. Ehsani M, Kebriaeezadeh A, Nikfar S, Akbari SA, Shahgholi E, Yousefimanesh H. Cost-utility of protocols of Ç£BFM ALLÇ¥ and Ç£UK ALLÇ¥ for treatment of children with acute lymphoblastic leukemia in Iran. Pediatr Blood Cancer 2016;63: S105.
    40. Nahvijou A, Daroudi R, Tahmasebi M, Amouzegar HF, Rezaei HM, Akbari SA. Cost-effectiveness of different cervical screening strategies in Islamic Republic of Iran: A middle-income country with a low incidence rate of cervical cancer. PLoS ONE 2016;11(6).
    41. Haghighat S, Akbari ME, Yavari P, Javanbakht M, Ghaffari S. Cost-effectiveness of three rounds of mammography breast cancer screening in iranian women. Iran J Cancer Prev 2016; 9:1-8.
    42. Zehtab N, Jafari M, Barooni M, Nakhaee N, Goudarzi R, Larry zadeh MH. Cost-Effectiveness Analysis of Breast Cancer Screening in Rural Iran. Asian Pac J Cancer Prev 2016; 17:609-614.
    43. Hatam N, Dehghani M, Habibian M, Jafari A. Cost-utility analysis of IEV drug regimen versus ESHAP drug regimen for the patients with relapsed and refractory hodgkin and non-hodgkin lymphoma in Iran. Iran J Cancer Prev 2015;8(5).
    44. Hatam N, Askarian M, Javan-noghabi J, Ahmadloo N, Mohammadianpanah M. Cost-Utility of "Doxorubicin and Cyclophosphamide" versus "Gemcitabine and Paclitaxel" for Treatment of Patients with Breast Cancer in Iran. Asian Pac J Cancer Prev 2015; 16:8265-8270.
    45. Aboutorabi A, Hadian M, Ghaderi H, Salehi M, Ghiasipour M. Cost-effectiveness analysis of trastuzumab in the adjuvant treatment for early breast cancer. Glob J Health Sci 2015; 7:98-106.
    46. Khatibi M, Rasekh HR, Shahverdi Z, Jamshidi HR. Cost-effectiveness evaluation of quadrivalent human papilloma virus vaccine for HPV-related disease in Iran. Iran J Pharm Res 2014; 13:225-234.
    47. Barouni M, Ghaderi H, Shahmoradi MK. The economic evaluation of screening for colorectal cancer: Case of Iran. Clin Lab 2013; 59:667-674.
    48. Sari AA, Ravaghi H, Mobinizadeh M, Sarvari S. The cost-utility analysis of PET-scan in diagnosis and treatment of non-small cell lung carcinoma in Iran. Iran J Radiol 2013;10: 61-67.
    49. Bastani P, Kiadaliri AA. Cost-utility analysis of adjuvant therapies for breast cancer in Iran. Int J Technol Assess Health Care 2012; 28:110-114.
    50. Ahmad KA, Bastani P, Hatam N, Ahmadloo N. Cost-effectiveness analysis of cancer treatments in south of Iran. Value Health 2010;13(7): A267-A268.
    51. Koopmans chap MA, Rutten FFH. The impact of indirect costs on outcomes of health care programs. Health Economics 1994; 3: 385-393.
    52. Cost-Benefit Analysis [online]. York; York Health Economics Consortium; 2016.
    53. Robinson R. Cost-utility analysis. BMJ1993; 307: 859 (doi:10.1136/bmj.307.6908.859)
    54. Mcgregor M. Cost–utility analysis: Use QALYs only with great caution. CMAJ 2003, 168, 433-434.
    55. Martins C, Godycki-cwirko M, Heleno B, Brodersen J. Quaternary prevention: reviewing the concept. European Journal of General Practice 2018, 24, 106-111.