Saja Almazrou

Background: Obesity is a growing public health crisis in Saudi Arabia. Community pharmacists are well-positioned to deliver accessible weight management services, but data on public willingness to pay (WTP) for these interventions remains limited. Aim: To assess the willingness of the Saudi Arabian public to pay for community pharmacist-led weight management services and identify factors associated with WTP. Methods: A cross-sectional, face-to-face survey was conducted among adults in a medical city in Riyadh between October 2025 and January 2026. WTP was elicited using the Payment Card method based on a hypothetical pharmacist-led service scenario. Payment values were validated by an expert panel. Univariable and multivariable regression models were used to identify independent predictors of WTP and payment amounts. Results: Of 746 participants, 66% expressed willingness to pay for the service. The most frequently selected maximum payment was 50 SAR per session. Multivariable logistic regression revealed that WTP was significantly associated with younger age, higher monthly income, perceived usefulness of pharmacy services (aOR: 3.10; 95% CI: 1.83–5.26), frequent pharmacy visits, and prior or desired access to a dietitian. Clinical burden, including BMI and chronic conditions, did not significantly influence WTP. Among those willing to pay, male gender was independently associated with a lower stated payment amount compared to females (β = −3.8 SAR; p = 0.006). Conclusions: Among adults attending a large academic medical city in Riyadh, there is substantial willingness to pay for pharmacist-led weight management services, with perceived value and healthcare engagement as the primary drivers. These preliminary findings warrant replication in broader, nationally representative samples.

Fibromyalgia (FM) is a chronic disorder characterized by widespread pain and multiple comorbidities and imposes a substantial economic burden on healthcare systems worldwide. Although extensively studied in Western countries, the economic impact of FM in Saudi Arabia remains unexplored. This study aimed to estimate healthcare resource utilization and the associated direct medical costs related to FM in a tertiary hospital in Saudi Arabia. A retrospective study was conducted using a bottom-up approach to assess the cost of illness associated with FM from a healthcare perspective. Analyzed data were extracted from February 2021 to February 2022 from the medical records of adult patients with FM who visited a tertiary healthcare hospital. Unit costs for each healthcare resource used in 2022 Saudi riyals (SAR) were obtained from the hospital’s billing system. The primary cost items were converted to US dollars (USD). Data were extracted from 128 patients. They were predominantly female (93%) with a mean age of 47.1 years. Most patients were either overweight (43.4%) or obese (41.6%), and 56.3% had three or more comorbidities. Rheumatology was the most frequently accessed specialty (52.3%). Antidepressants were the most prescribed medications (77.3%). The average annual direct medical cost per patient was SAR 9,601.2 (USD 2,560.3), with healthcare team specialist visits and diagnostic procedures constituting 50.7% and 45.6% of the total costs, respectively. Laboratory tests imposed the highest financial burden (mean cost per patient: SAR 3,268.5 ; USD 871.6), whereas medications contributed only 3.7% of the total costs. FM places a substantial burden on the Saudi healthcare system. Although the annual cost falls within the average global range, healthcare team visits followed by diagnostic procedures are the main drivers of FM costs. These findings provide essential knowledge for healthcare planning and resource allocation by policymakers aiming to reduce the costs associated with FM in Saudi Arabia.

Background: Countries in the Middle East and North Africa (MENA) face increasing pressure to optimise healthcare spending through evidence-based decision making. Economic evaluation guidelines (EEGs) are key policy tools that standardise the conduct and reporting of health economic analyses and inform reimbursement decisions. This study systematically compares national EEGs across MENA countries using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) framework. Methods: A systematic search was conducted to identify national EEGs in the MENA region. Primary sources included the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) repository and the Guide to Economic Analysis and Research (GEAR), supplemented by searches of bibliographic databases and grey literature. Extracted data were mapped against CHEERS checklist domains and supplemented with information on guideline scope, methodological requirements, and implementation status. Results: Four national EEGs were identified for Saudi Arabia, Egypt, Lebanon, and Tunisia, published between 2015 and 2025. Three were mandatory, while the Egyptian guideline was advisory. All guidelines required clear definition of target populations, comparator selection, appropriate time horizons, and evidence on effectiveness. However, substantial variation was observed in model structure, handling of uncertainty, perspective, costing approaches, and decision thresholds. The Saudi and Tunisian guidelines showed closer alignment with CHEERS domains, particularly in model transparency and sensitivity analysis requirements. Conclusions: EEGs in the MENA region differ considerably in methodological detail, enforcement, and institutional maturity, reflecting uneven development of health technology assessment systems. Harmonisation efforts should focus on core methodological standards while allowing contextual adaptation to national health system priorities.

Irritable bowel syndrome (IBS) is associated with impaired health-related quality of life (HRQoL) and a high burden of comorbid mental health conditions, However, limited population-level evidence exists. Therefore, this study examined the relationship between anxiety, depression, and HRQoL among adult and elderly populations with IBS in the United States. A cross-sectional observational analysis was conducted. Data were drawn from the 2017–2022 Medical Expenditure Panel Survey (MEPS). Adults aged ≥18 years with a diagnosis of IBS were included. HRQoL was assessed using the Veterans RAND 12-Item Health Survey, generating Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Adjusted multivariable linear regression models provides weighted national estimates for the associations between IBS groups (IBS only, IBS with anxiety, IBS with depression, and IBS with both) and HRQoL. Depression and anxiety were identified from MEPS using the ICD-10-CM codes. Subgroup analyses compared adults (18–64 years) and older adults (≥ 65 years). Among 595 adults with IBS, most were women (78%) and aged >65 years (39%). IBS with comorbid depression and/or anxiety was strongly associated with lower HRQoL. Participants with both depression and anxiety reported the poorest HRQoL (PCS mean = 38.84; MCS mean = 39.20). Regression analyses showed significant reductions in both PCS and MCS for individuals with comorbid psychiatric disorders compared with IBS only (all p<0.001). In age-stratified analyses, depression and anxiety were primarily associated with larger declines in mental HRQoL among younger adults, whereas in older adults these comorbidities were associated with reductions in both physical and mental HRQoL, with greater overall impairment in the presence of chronic comorbid conditions. Protective factors included employment, higher income, physical activity, and good self-rated health. Comorbid depression and anxiety substantially reduce both physical and mental HRQoL among individuals with IBS, with distinct age-specific patterns. Younger adults are primarily affected in mental domains, whereas older adults experience broader impairment in in physical and mental domains. These findings suggest the need for integrated clinical approaches that address both IBS and mental health to improve overall HRQoL in IBS patients.

Objectives: This study aim to determine the characteristics, roles, responsibilities, and challenges of informal caregivers for adult patients in Saudi Arabia. Methods: Adult patients who have informal caregivers were invited to participate in a cross-sectional study. The inclusion criteria were patients who were 18 years old or older and permanent Saudi residents. A self-administered online questionnaire was used to identify patients’ demographics, roles, responsibilities, and care challenges. Data collection lasted four months. Percentages, means, and standard deviations were reported in the analysis. Results: The study included 276 participants, mostly female (68.8%), with a mean age of 55.21 years (SD = 20.3). Over half were married (56.2%) and not employed (81.9%). Common chronic diseases were diabetes and hypertension, with 55.8% using up to five medications. Caregivers were mainly sons or daughters (62%) living with the patient (84.1%). The top caregiver tasks were escorting patients to appointments (63.4%), scheduling doctor appointments (60.1%), and tracking medication refills (59.4%). Common challenges included caregivers lacking time (45.3%), inconsistent care (35.9%), financial constraints (27.5%), and caregivers missing doses (27.9%). The top not encountered challenges were inappropriate medication storage (78.3%), communication barriers (74.3%), improper disposal of injections (72.5%), medication management errors (71.4%), and lack of empathy (70.3%). Conclusion: This study highlights the vital role of informal caregivers in managing chronic illnesses in Saudi Arabia. Informal caregivers face challenges such as time constraints and financial limitations. The findings emphasize the need for better support systems, including training programs and improved access to healthcare resources, to enhance care quality for patients.

Ofatumumab, a fully human anti-CD20 monoclonal antibody, is a promising disease-modifying therapy (DMT) for relapsing-remitting multiple sclerosis (RRMS). This study investigates its cost-effectiveness compared to teriflunomide from the perspective of Saudi healthcare payers. This comparison is crucial for informing treatment strategies and resource allocation in Saudi Arabia, where RRMS poses a significant healthcare burden and access to newer DMTs is evolving. A Markov model was constructed to evaluate the long-term cost-effectiveness of ofatumumab compared to teriflunomide for treating RRMS in Saudi Arabia. This model simulates disease progression over 10 years, a timeframe chosen for its clinical relevance and consistency with similar studies. To reflect the Saudi patient population, the model uses a hypothetical cohort with characteristics mirroring those in the ASCLEPIOS I/II clinical trials. The model incorporates transition probabilities between disease states, primarily derived from the British Columbia MS (BCMS) database and further refined using data from the ASCLEPIOS trials. To ensure relevance to the Saudi context, local data sources were utilized, including drug costs from the Saudi Food and Drug Authority (SFDA) and health state costs from published local studies. Clinical expert input was incorporated to validate model assumptions.The primary outcome measure was the incremental cost per quality-adjusted life-year (QALY) gained. Sensitivity analyses were conducted to assess the robustness of the model findings. Compared to teriflunomide, ofatumumab yielded incremental cost-effectiveness ratios (ICERs) of $46,188 per QALY over the 10-year period. Ofatumumab demonstrated a greater impact on reducing disability progression, particularly in the early stages of the disease. At a willingness-to-pay (WTP) threshold of $99,120 per QALY, ofatumumab demonstrated a 99.14% probability of cost-effectiveness in probabilistic sensitivity analyses. This cost-effectiveness analysis demonstrates that ofatumumab is a cost-effective treatment for RRMS in Saudi Arabia, with an ICER below the WTP. Policymakers should consider including ofatumumab in national formularies and prioritize its use in early-stage RRMS to maximize patient benefit and cost-effectiveness.

Background/Aim: Fibromyalgia (FM) is a complex and debilitating condition that significantly impacts patients’ daily lives. The continuous assessment of the impact and severity of FM is essential to manage the condition effectively. Assessment tools in Arabic are lacking for use in Saudi Arabia, which might lead to ineffective management. This study aimed to translate and cross-culturally adapt and validate the Arabic version of the Revised Fibromyalgia Impact Questionnaire (FIQR). Methods: Following translation guidelines, 2 Arabic translators and 2 English-certified translators performed forward and backward translations of the FIQR. In a cross-sectional study design, the questionnaire was piloted with 5 participants and then subjected to cognitive interviews and psychometric analysis. Participants were FM patients recruited from a University Hospital in Riyadh and FM support groups in Saudi Arabia. The internal consistency, and reliability using the Cronbach α and interclass correlation coefficient (ICC) of 2-week test–retest, and criterion validity were evaluated. Results: The results included a total of 42 participants with FM. Six minor modifications were made during the stepwise translation of the questionnaire. The Arabic version of the FIQR had good internal consistency and test–retest reliability, with a Cronbach α of 0.855 for the physical functioning domain, 0.663 for overall well-being, 0.803 for symptoms, and 0.895 for the total FIQR, and the Pearson correlation coefficient of the ICC for physical functioning was 0.769 (95% confidence interval (CI), 0.541– 0.884) for the overall well-being domain, 0.555 (95% CI, 0.129– 0.772) for the symptoms domain, and 0.720 (95% CI, 0.370– 0.868) and 0.794 (95% CI, 0.579– 0.899) for the total FIQR score (p < 0.001), respectively. Conclusion: The Arabic version of the FIQR is a valid, reliable, and practical tool for assessing the impact of FM on Arabic-speaking patients and potentially contributing to the improvement of FM outcomes.

Background: Chemotherapy safety guidelines have been enacted to minimize their side effects on healthcare providers when handling medications. The aim of this study is to assess the impact of an educational intervention on healthcare workers’ compliance with chemotherapy safety guidelines. Methods: In this study, we used a quasi-experimental, pre-post testing design. It was conducted in the Oncology center at King Saud University Medical City (KSUMC) in Riyadh, Saudi Arabia. All healthcare workers involved in the preparation and administration of chemotherapy medications in KSUMC were invited. We evaluated Educational intervention to ensure the compliance of healthcare workers with standard safety guidelines through a questionnaire with 29 questions in total. Results: Fifty-two participants were eligible in this study. Overall, the score for mean compliance with workplace guidelines among the participants increased from 17.62∓0.78 to 18.17∓0.80 out of 19. Multiple liner regression indicates that there are no variables among the included variables predicting a change in post-intervention. Conclusion: This study indicates that educational intervention is the only effect of compliance in the included sample. Education safety training could improve healthcare workers’ knowledge and consequently improve their compliance in the preparation and administration of chemotherapy medication.

Background: Clinical practice guidelines (CPGs) improve clinical decision making and patient outcomes, but CPG implementation is poor. The success of CPGs is influenced by several factors related to barriers and facilitators. For this reason, it can be extremely useful to explore key barriers and facilitators of CPG implementation in the Middle East and North Africa (MENA). Methods: A three-round Delphi study was performed using the input of 30 experts involved in the clinical practice guidelines. In the first two rounds, participants were asked to score each statement relevant to barriers or facilitators for CPG implementation on a five-point Likert scale. These statements were identified from existing systematic reviews and expert input. In round three, participants ranked the most important barriers and facilitators identified from rounds one and two. A descriptive analysis was conducted on the barrier and facilitators statements using frequencies, percentages, and medians to summarize the variables collected. Results: We identified 10 unique barriers and 13 unique facilitators to CPG implementation within the MENA region. The two highest-ranked barriers related to communications and available research and skills. The most important facilitator was the availability of training courses for healthcare professionals. Conclusions: Key barriers and facilitators to the implementation of clinical practice guidelines seem to exist in professional, organizational, and external contexts, which should all be taken into account in order to increase implementation success within MENA region. The results of this study are useful in the design of future implementation strategies aimed at overcoming the barriers and leveraging the facilitators.

Background: Interprofessional education (IPE) in healthcare specialties is important to optimize patient outcomes and shape professional image toward teamwork and collaboration among healthcare professionals. The aim of this study is to assess the impact of IPE on pharmacy and clinical nutrition students’ knowledge in food–drug interactions and readiness for interprofessional learning. Methods: This pre-post study was conducted at King Saud University between February and March 2020. We held an interprofessional workshop for pharmacy and clinical nutrition students. After we introduced the faculty members who would deliver the food–drug interactions session, the students took a seven-question quiz (total score = 7) to assess their knowledge about the basic concept of food–drug interactions before the session. After that, a 45-minute lecture was provided by a clinical pharmacy faculty member. Students from both disciplines worked on three clinical scenarios. After completing the assigned scenarios, the students retook the quiz to assess their knowledge after the workshop. In addition, student readiness was assessed using the 19-item Readiness for Interprofessional Learning Scale (RIPLS). Results: A total of 48 students were included in this study. Overall, students’ mean scores in both colleges significantly increased after the workshop (p < 0.01). The mean RIPLS total scores (SD) for pharmacy students and clinical nutrition students were 80.6 (7.48) and 81.26 (6.96), respectively, out of a maximum possible score of 95. These scores indicated positive attitudes toward interprofessional learning in both groups. Conclusion: Pharmacy and clinical nutrition students’ knowledge regarding food–drug interaction improved after implementing the IPE session. Students also reported higher scores for interprofessional learning. This indicates their willingness to participate in future interprofessional learning activities. Roles and responsibilities domain scores were slightly lower among both groups. Simulation-based activities including profession role exchange can be added to traditional IPE sessions to improve this domain.