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Title: Health economics in cardiovascular medicine studies comparing healthcare practice in the United Kingdom and Iran
Author: Parsa, Ali Davod
Awarding Body: University of Nottingham
Current Institution: University of Nottingham
Date of Award: 2011
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Coronary heart disease (CHD) is associated with a high morbidity and a high mortality, especially premature death, in low and middle-income countries, in developing countries such as Iran and in developed countries such as the United Kingdom. CHD affects individuals in their peak mid-life years, altering the future of family dependents and damaging the development of a population by its impact on productivity. Treatment of CHD consumes a significant proportion of health system capacity. Among decision makers, treatment costs can be just as important as the beneficial effects of treatment on health and maintaining quality of life. To control increasing demand, resources need to be allocated most effectively. Cost benefit analysis and assessment of willingness to pay (WTP) are health economics techniques that might be utilised for assigning priority of resource use and to better match costs of and demands for health care. In spite of vast experiences of applying health economics in the west, developing countries like Iran are only at the beginning of this process. A few WTP studies in health in Iran have been carried out but there is no reported use of WTP in CHD. This thesis consists of one study in each of two different communities, which together provide key information on one aspect of the economic evaluation of coronary heart disease in Iran and UK, which potentially can be used in policy-making relevant to a developing nation such as Iran, faced with an impending epidemic of CHD in the next ten years. Different approaches to health economics analysis are described. This 'willingness to pay' study compares patients' preferences with healthy volunteers in both the UK, where healthcare is predominantly publicly funded and in Iran, where a mixture of public and private healthcare is in place. To compare the main health care concerns in the UK and Iran on management of cardiovascular disease using epidemiological factors and a health economics tool; cost benefit analysis. This study is to address the scale of potential risk, losses and benefits of decisions made in the management of coronary heart disease in a developing country like Iran compared with a developed country such as the UK. Objectives ~ To establish what communities may be willing to sacrifice to prevent a heart attack or, in the event of a heart attack, to receive the best treatment and avert death risk ~ To find out whether individuals might be prepared to pay for prevention or new treatment of heart disease before it becomes widely available ~ To establish community preferences if they were required to prioritise the health services Design 1 - Perspective The perspective of WTP study is societal. 2 -Methods Using different elicitation methods in WTP, survey data were obtained from four sources in the UK and six centres in Iran. The WTP values in different scenarios amongst patients, family member of patients and healthy volunteers in each country have been compared. Several predictors influencing on individuals' WTP such as: household income, education, employment, quality of life age, gender and socioeconomic class have been investigated. Individuals' attitudes toward health priorities have been approached. 3 -Setting This WTP study is a comparative survey study, comparing AMI patients, healthy volunteers and members of the family of patients in Iran with the UK. The Nottingham population comprised patients under the care of cardiologists at Nottingham University Hospitals, and healthy volunteers selected from general practices. Iranian patients and volunteers were similarly recruited from Qazvin teaching hospital, Shahid Beheshti hospital and several health centres. 4 - Participants The study populations described in this thesis were selected from adults in British and Iranian communities. Within each community, subjects either were patients with a history of heart attack or were a healthy, volunteer group, comprising family members of patients, not known to have CHD. Data collection Data has been collected from 518 participants in Iran and 309 participants in the UK for WTP. Outcome measures Willingness to pay or willingness to accept for different health gains Data analysis SPSS (version 11.00, 15.00) and Excel software (office 2003) were used. Univariate and multivariate analysis like regression analysis and descriptive statistics were applied as appropriate. Results - Willingness to pay Most participants in both countries were willing to pay for either treatment, prevention of CHD, reduction of mortality and saving life. Education, income, having insurance, quality of life, social class and some other confounders influenced WTP but there were significant differences between the two communities. - Prioritisation The public, whether patients or not, were willing to prioritise and were motivated to rank the CHD as a top priority in healthcare for extra allocation or re-allocation of resources. Conclusion Patients, not usually involved in the prioritisation of health care services, can have an impact on decision-making through willingness to pay and willingness to accept techniques. This study has presented a high community profile for treatment, prevention of CHD in both countries, which will be instructive to decision makers.
Supervisor: Gray, David ; Whynes, David K Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available