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.
In a resource-limited world, there is an urgent need to develop new economic models, from the traditional unsustainable industrial model of product consumption and disposal, to a new model based on the concepts of sustainability in its comprehensive sense, the so-called circular economy, using fewer resources in manufacturing processes and changing practices in product disposal to waste, by removing its use, recycling and manufacturing to start another manufacturing process. In an era of intense competition in domestic and global markets, the importance of the circular economy is highlighted in its ability to strengthen the competitiveness of enterprises in those markets, by reducing the cost and increasing the quality of the pro
... Show MoreReceipt date:2/17/2021 acceptance date:3/16/2021 Publishing date:12/31/2021
This work is licensed under a Creative Commons Attribution 4.0 International License.
Objective: This paper investigates the contradictions in the decision-making process of the United States, which historically proven to be successful policies in the short term, but in the long term proven to be wanting and failure. Methodology: The paper uses descriptive, historical, comparative method. A
... Show MoreIntervention in International Relations from the concepts that are still highly
controversial among those he considers a breach of international law and the UN Charter and
in violation of the rule , and those who felt that the need provided, however, that this is linked
motives humanity recognized by the international community , because the international
variables proved the inadequacy of the principle of non-interference and the principle of
sovereignty as the traditional variables international , and therefore most of the international
practice came a bus with many of the behaviors that reflect a decline in its entirety to these
principles , and became adapt these principles with international reality is too compl
This study examined the tagged (the matter, its ruling, and examples of its applications in Ahmadiyya interpretations), the study of devising formulas of commissioning, especially the matter from the book of interpretation, which is: (Ahmadiyyeh’s interpretations), and the contemplative of the nature of (Ahmadiyya’s interpretations) realizes that the cognitive, linguistic and juristic knowledge product and the verses of judgments And other is the focus of this immortal travel, as it is truly a comprehensive book containing what the students of knowledge, scholars and the general public need in terms of interpreting the legal verses, and it is not possible to reach an understanding of the Book of God Almighty, and to clarify his purpo
... Show MoreThe implicit pattern is one of the cultural patterns that are present in both the text and theatrical presentation and the reading of the implicit pattern cannot take place without cognitive references, whether audio or visual as well as historical references and the natural, social and psychological dimensions of communities and individuals.
The researcher, in this study, attempted to focus on the axis of the aesthetic preoccupations of the implicit pattern in the theatrical presentation and the definition of the implicit pattern. Methodologically speaking, the research problem focused on revealing the outlines and the main features in the aesthetic preoccupations that shape the i
... Show MoreThe main purpose of this research aims to measure the role of banking strategies marketing in achieving competitive advantage within a sample of Iraqi private banks, and in order to achieve this purpose, the researcher depend on number of sober research approaches which consisted of descriptive, analytical and practical methodologies, to strengthen concepts addressed by the research, size of the sample was (56) individuals which makes up the senior leadership represented (Chairman and members of the Board of Directors, Commissioners and their assistants and department heads) while the primary tool for research (questionnaire), which has been designed based on a number of solemn scientific metrics, after adapted these metrics commen
... Show MoreThis study is intended to examine the concept of transcultural identity in the travel book The Global Soul: Jet Lag, Shopping Malls, and the Search for Home by (Iyer, 2001). Jeffries’ model of critical stylistics (2010) (henceforth, CS) has been selected to analyze the book. To be more specific, Negation is selected to analyze the concept under study. As such, the study aims at finding out how Negation is used to portray ideological meanings representing the concept of transcultural identity in one non-fictional travel book; and finding out the ideologies related to the concept analyzed. The analysis of the data shows that Negation is a suitable analytical tool to reach the ideational meaning of the text towards the concept of tra
... Show MoreA procedure, depending on the derivatization and determination of aniline was depicted andvalidated in this study. 8-hydroxyquinoline (8-HQ) was used as the derivatizing agent for thedetermination of aniline. An optimization study was performed for the derivatization reaction, i.e.,the diazonium coupling reaction, the optimum parameters were as follows: 22 mM of hydrochloricacid, 54mM of sodium hydroxide, and 1.8mM of sodium nitrate. The optimization study of themethod of cloud point extraction (CPE) revealed that the extraction solvent was 0.5 ml of Triton X-100, the optimum temperature was 90 °C, and the incubation time was 25 min. The linearity,correlation coefficients, molar absorptivities, and limits of detection were improved using t
... Show MoreIn light of increasing demand for energy consumption due to life complexity and its requirements, which reflected on architecture in type and size, Environmental challenges have emerged in the need to reduce emissions and power consumption within the construction sector. Which urged designers to improve the environmental performance of buildings by adopting new design approaches, Invest digital technology to facilitate design decision-making, in short time, effort and cost. Which doesn’t stop at the limits of acceptable efficiency, but extends to the level of (the highest performance), which doesn’t provide by traditional approaches that adopted by researchers and local institutions in their studies and architectural practices, limit
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This study aims to identify the issue of observing media publishing and its importance for public relations in the management of special events; and its role in building the positive image of the target audience through communication messages that illustrate the political, economic and diplomatic importance of the Arab Summit. As such Summit is one of the conferences that Iraq sought to secure the requirements of its convening to re-activate its political and diplomatic role in the Arab Ocean, especially after the circumstances and crises that Iraq went through.
The convening of the Arab Summit under the auspices of Iraq was a qualitative transition, during which Iraq sought to achieve some gains b
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