Since up to 60 percent of health care expenditures in developing countries are allocated to pharmaceutical products, utilizing this budget in order to supply pharmaceutical products is important. Good Procurement Practice (GPP) with the assistance of various ways of tendering is one of the most cost-effective methods in this matter. Studies showed that adding one extra supplier to tendering will cause 10 percent price reduction on average which is considered the most important outcome of tendering. In cases where there are many suppliers, tendering is recommended as a strong method in pricing and reimbursement.   It seemed that GPP in reimbursement companies is not sufficient in Iran. Although bidding in countries that have developed in the generic markets is more common than those that are reaching this goal, it is recommended that reimbursement companies use bidding for inpatients, outpatients, specific patients and product groups, vaccines, and bulk products in cumulative and regional and national level. These would result in optimum use of the public budget. 

Objectives: The significant increase of type 2 diabetes and its complications in individuals requires developing new approaches to control this disease. The present study aimed to evaluate the efficacy of pioglitazone and insulin combination therapy, compared to insulin therapy in patients with type 2 diabetes. Methods: Medline, Cochrane Library, and Embase were searched for Randomized Controlled Trials (RCTs) comparing pioglitazone in combination with any insulin-containing regimen and the same insulin regimen alone in patients with type 2 diabetes. Hand searching was conducted in journals, congresses, and RCT registration databases related to diabetes. There were no restrictions on the language and publication year of articles. RCTs were evaluated based on the inclusion and exclusion criteria; the quality of studies was evaluated using the Jadad and the Cochrane collaboration’s tools. After evaluating and extracting the data, thecommon results of the selected papers were entered in RevMan. Furthermore, in the cases that studies were homogeneous, meta-analysis was performed; in the cases that studies were heterogeneous, the findings were reported in a qualitative form. Results: From the first found essays, 12 were elected for studying, including a total of 3208 patients with type 2 diabetes. The trial duration was between 12 weeks and 34.5 months. The study results presented a reduction in HbA1c and insulin dose in the combination therapy with pioglitazone arm. In our meta-analysis, the mean reduction in HbA1c was equal to 0.64%, i.e., significant [95% Confidence Interval (CI): -0.86 to -0.41, P<0.00001]. Conclusions: This systematic review indicated that in patients with type 2 diabetes, the addition of pioglitazone to the insulin regimen, compared to the insulin regimens, reduced HbA1c.

Background: Beta-blockers are preferred anti-hypertensive for patients with compelling indications. Vasodilator beta-blockers are of particular benefit in blood pressure control and other cardio-metabolic components with limited disturbance in metabolic parameters. There is inadequate evidence on the superiority of vasodilator beta-blockers over non-vasodilator beta-blockers in treating hypertension. Therefore, this systematic review aimed to generate evidence on the clinical effects of non-vasodilator and vasodilator beta-blockers in treating hypertension in adultsMethods: We searched articles in English published from January 2000 to January 2020 from the following databases: PubMed/Medline, Web of Science, and Google scholar. We considered the following search query: “clinical effectiveness AND vasodilator beta-blockers AND non-vasodilator beta-blockers AND adult hypertension treatment AND clinical trials”.Results: Nine randomized and controlled trials conducted in 3088 adult hypertensive patients were reviewed. All studies agreed on the comparable antihypertensive efficacy of vasodilating and non-vasodilating beta-blockers. Non-vasodilating beta-blockers significantly reduced heart rate, increased blood glucose, blood cholesterol, and triglycerides. Vasodilator beta-blockers were associated with better cardiometabolic risk reduction, better safety, and oxidative stress reduction.Conclusion: The hypertensive efficacy of vasodilating and non-vasodilating beta-blockers were comparable. Vasodilating beta-blockers were associated with better cardiometabolic risk reduction, better safety profile, and better oxidative stress reduction. However, there is insufficient evidence regarding the superiority of vasodilating and non-vasodilator betablockers. Therefore, it is essential to conduct comprehensive clinical trials by involving different ethnic groups to determine the benefit of vasodilator beta-blockers over non-vasodilators for treating hypertension.

Background: Quality Assurance Structure (QAS) plays an essential role in the profitability and market size of pharmaceutical companies. Accordingly, this study aimed to evaluate the quality certificates and QAS of pharmaceutical companies in Iran. Quality principles can increase consumer satisfaction, leading to elevated sales and profitability for companies. Besides, they have always been accompanied by growth and development. A well-established quality would be greatly valuable; if properly managed, it could influence the development of pharmaceutical companies.Methods: In this study, the data of sales, operating profit, quality certificates, organizational chart, and quality staff were received by companies. Moreover, we made appointments with each company and received the real data directly from the relevant officials. The quality certificates and relative percentage of quality staff were collected and compared with the domestic sales, exports, and operating profit of companies. Finally, the achieved results were analyzed to determine the relationship between financial and qualitative parameters.Results: The relationship between QAS and sales and corporate profitability was determined. The present study data indicated a relationship between the qualitative and financial sectors of pharmaceutical companies.Conclusion: Prior surveys and the obtained data suggested that quality structure and quality certificates significantly increase the domestic sale, export, and profitability of companies. However, numerous other parameters can also be involved in the sales volume of companies that require further investigations.

Background: The prescribed doses of medications used for chronic diseases can be a good index for assessing inequality in healthcare services employment in communities. This study aimed to evaluate inequality in the prescribed dose of anti-dementia medications from 2012 to 2015 in the claim data, in Iran.Methods: This study used the data on the prescribed dose of anti-dementia medications registered by the Social Security Organization (SSO) of Iran. The data on wealth index and educational attainment were extracted from Household, Income, and Expenditure Surveys (HIES) and merged into the claim data. Univariate and multivariable ordinal logistic regression models were applied to evaluate the factors associated with the prescribed dose of antidementia medications. DASP Stata package was used to calculate Gini and concentration indices.Results: In multivariable models, prescription year, age, and educational attainment were related to the prescribed dose of anti-dementia medications. From 2012 to 2015, Gini indices of the prescribed dose of donepezil and rivastigmine were decreased. Gini indices in wealthier subjects were smaller than that in poorer individuals. Furthermore, with increasing the subjects’ age up to the age of 80 years, Gini indices were decreased. Concentration indices were positive about rivastigmine, donepezil and memantine.Conclusion: Different levels of inequality in the prescribed doses of donepezil and rivastigmine were observed among various wealth and education quintiles. Inequality in the prescribed doses of both mentioned medications was reduced from 2012 to 2015 among individuals under the SSO coverage in Iran.

Background: As an antibiotic, vancomycin presents numerous benefits in controlling methicillinresistant staphylococcal infections; however, if used inappropriately, it can lead to bacterial resistance in patients. The current study aimed to evaluate the financial burden of inappropriate use of Vancomycin in patients with cancers in selected university hospitals in Shiraz.Methods: This descriptive cross-sectional study was conducted in 2017-2018. The required data were collected using a checklist. In total, 150 adult patients with cancer were selected by the census method. moreover, the t-test, Chi-squared test, and Analysis of Variance (ANOVA) were used to examine the relationship between the study variables where appropriate.Results: The present study results suggested that inappropriate prescribing of vancomycin had a frequency of 61 (59.2%) in Namazi Hospital and 22 (46.8%) in Amir Hospital; thus, there was no significant difference between these hospitals concerning the types of prescriptions (P=0.15). It was also found that the inappropriate use of vancomycin cost the patients $1974.2 and $1046.5 in Namazi and Amir hospitals, respectively.Conclusion: The present study data indicated that the most frequent problems were the inappropriate prescription of vancomycin in hematology wards, the lack of drug discontinuation at the proper time, and the continuation of drug administration more than the patients’ needs. Thus, conducting regular educational programs for physicians per relevant guidelines could help reduce unreasonable administration of the drug and the financial burden imposed on patients.