Abstract Background: The novel coronavirus 2 (SARS?CoV?2) pandemic is a pulmonary disease, which leads to cardiac, hematologic, and renal complications. Anticoagulants are used for COVID-19 infected patients because the infection increases the risk of thrombosis. The world health organization (WHO), recommend prophylaxis dose of anticoagulants: (Enoxaparin or unfractionated Heparin for hospitalized patients with COVID-19 disease. This has created an urgent need to identify effective medications for COVID-19 prevention and treatment. The value of COVID-19 treatments is affected by cost-effectiveness analysis (CEA) to inform relative value and how to best maximize social welfare through evidence-based pricing decisions. Objective: compare the clinical outcome and the costs of two anticoagulants (heparin and (enoxaparin)) used to treat hospitalized patients with COVID-19 infection. Patients and method: The study was a retrospective review of medical records of adult, non-pregnant, COVID-19 infected hospitalized patients who had baseline and last outcome measurements at Alamal Epidemiology Center, Al-Najaf city from (Augast 2020 to June 2021). The outcome measures included D-dimer, length of stay (LOS), and mortality rate. Only the cost of the medical treatment was considered in the analysis. The pharmacoeconomics analysis was done in three different cost-effectiveness analysis methods. Microsoft Excel spreadsheet and Statistical Package for the Social Sciences software (SPSS), was used to conduct statistical analysis. Kaplan Meier test was used to compare the mortality rate. T-TEST was used to compare the outcomes of the two groups. Results and discussion: two groups were compared, the first group consists of 72 patients who received heparin, and the second group consists of 72 patients who received enoxaparin. COVID-19 infected patients had a higher abnormal average D-dimer (2534.675 ng/dl). No significant differences between both genders with regards to the basal average D-dimer (males= 2649.95 ng/dl, females= 2374.1mg/dl, P-value>0.05). There was a significant difference between patient's ages 60 years and patients <60. (3177.33 ng/dl, 1763.06 ng/dl, P-value <0.05). It seems that, higher D-dimer levels were associated with a higher mortality rate (died=3166.263 ng/dl, survived= 1729.94 ng/dl, P-value <0.05). Heparin was more effective in decreasing D-dimer levels than enoxaparin which inversely increased the D-dimer levels (-24.4 ng/dl/day, +154.701 ng/dl/day, P-value <0.05). Additionally, heparin was more effective in increasing the survival rate compared to enoxaparin (55% vs, 35%, P-value<0.05). Heparin was associated with a longer duration of stay in hospital than enoxaparin but with no significant difference (13.7 days, 12.3 days, P-value >0.05). Concerning the cost, treatment with heparin cost less than enoxaparin (2.08 U.S $, 9.44 U.S $)/per patient/per day. Conclusion: Originator heparin was a more cost-effective anticoagulant therapy compared to originator enoxaparin, it was associated with a lower cost and better effect, treatment with Heparin resulted in positive INB= 11.3, where a positive result means that heparin is more cost-effective than Enoxaparin. All three methods of pharmacoeconomic analysis decide that heparin was more cost-effective than enoxaparin in treating COVID-19 infected patients.
Abstract
Performance evaluation is of great importance in all countries of the world, because it has a prominent and effective role in determining the efficiency and effectiveness of the optimal use of available resources, which are rare and important in achieving the desired objectives. With the continued growth of public spending and the limited resources, the State seeks to achieve its objectives through its units with minimal expenditure or deficit, rationality and wastefulness in the spending. In many countries, particularly developing countries, reforms are made in the public sector to achieve that goal through the adoption of IPSAS, which is reflected in the developmen
... Show MoreWith growing global demand for hydrocarbons and decreasing conventional reserves, the gas industry is shifting its focus in the direction of unconventional reservoirs. Tight gas reservoirs have typically been deemed uneconomical due to their low permeability which is understood to be below 0.1mD, requiring advanced drilling techniques and stimulation to enhance hydrocarbons. However, the first step in determining the economic viability of the reservoir is to see how much gas is initially in place. Numerical simulation has been regarded across the industry as the most accurate form of gas estimation, however, is extremely costly and time consuming. The aim of this study is to provide a framework for a simple analytical method to esti
... Show MoreThe size and the concentration of the gold nanoparticles (GNPs)
synthesized in double distilled deionized water (DDDW) have been
found to be affected by the laser energy and the number of pulses.
The absorption spectra of the nanoparticles DDDW, and the
surface plasmon resonance (SPR) peaks were measured, and found to
be located between (509 and 524)nm using the UV- Vis
spectrophotometer. SPR calculations, images of transmission
electron microscope, and dynamic light scattering (DLS) method
were used to determine the size of GNPs, which found to be ranged
between (3.5 and 27) nm. The concentrations of GNPs in colloidal
solutions found to be ranged between (37 and 142) ppm, and
measured by atomic absorptio
Background: The gene responsible for encoding the protein of cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) has been found to be associated with rheumatoid arthritis (RA) in different ethnic populations. But the association of +49A/G CTLA-4 polymorphism with susceptibility of RA among Iraqi Arab populations has not yet been determined. Methods: One hundred and seventy-eight patients were examined, 67 of them were males (mean age 54.71 ± 10.4 years), while 167 were examined for the control group, of whom 64 were males and the rest were females. CTLA-4 DNA genotyping was carried on to determine the +49 A/G (rs231775) polymorphism using a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Enzyme-linked immuno
... Show MoreThe technology and modern social communication medias have contributed to changing many of our concepts about education to a large extent; these technological advancements have created new challenges for the Instructor of course, but on the other hand it did provided him with expressive media, models and strategies that the old methods cannot fulfill, including the flipped classroom strategy, which is one of the modern technical solutions and in it's optimal use it can correct the weakness of the traditional education and can develop the communication skills as a whole among the students, in order to create a positive, active and interactive student.
The current research contained - four chapters: the first one included the methodolog
The current research aims to analyze the extent of the adoption of the standards of ISO 45001: 2018 for occupational safety and health management by the General Establishment of Civil Aviation. The research problem was the extent to which the General Establishment of Civil Aviation approved ISO 45001: 2018 for occupational safety and health management. The questionnaire was used as a primary data collection tool, the sample was distributed (50) form, they were selected from the category of employees of the establishment at different levels to represent the research community. Data were analyzed using the statistical package (SPSS), a number of vector statistical methods were used as well as arithmetic mean, standard deviation, an
... Show MoreThe aim of this research is to identify the effect of Webinar technique on digital culture in the College of Education for pure sciences at Ibin Haitham, University of Baghdad. The research samples consisted of (68) male and female students from the Chemistry Department who are following classes during the (2019- 2020) academic year. The samples represent (42%) of the total number of (162) students split into control and experimental groups. For this purpose, the scientific contents for testing were determined. The experimental part is based on analysis of the results from experiments in (preliminary standard solutions, refractive index, Beer-Lambert law). To achieve the aim of the research in testing the measure of student's digital cultur
... Show More