THE CURRENT SITUATION OF WATER RESOURCES IN IRRIGATED AGRICULTURE OF UZBEKISTAN

Irrigation in Uzbekistan is of great importance since the country is an arid zone. The use of water in agriculture is described and its relationship as a constraint to economic development discussed. The current technical and organizational characteristics of irrigation systems need study and analysis to identify opportunities for improvements. The characteristics of demand for water at the farm level are described and irrigation and land improvement activities are outlined. Reform of water user rights are necessary in order to improve the management of existing water resources. Existing regulations and possible improvements are presented.Resource /Energy Economics and Policy,

THE DEVELOPMENT OF SUSTAINABLE INSTITUTIONAL STRUCTURES FOR WATER USE IN UZBEKISTAN

Currently the management of irrigation systems in Uzberistan is carried out by state water organizations at all levels (national, regional, and district). As the irrigation system was developing the size of some areas was increasing. An analysis of the current situation illustrates that with increases in yield and water use no proper operation and maintenance of the systems was provided which resulted in their breakdown; so that new investments are required for restoration. However, the structure and functions of existing institutions, resulting in lack of incentives for individuals, are not likely to achieve efficient water use and operation of the system. It is therefore considered that institutional reforms are required to provide incentives for more efficient operation and maintenance of irrigation systems, while reducing costs.Resource /Energy Economics and Policy,

Economic evaluation of smoking cessation in Ontario's regional cancer programs.

Quitting smoking after a diagnosis of cancer results in greater response to treatment and decreased risk of disease recurrence and second primary cancers. The objective of this study was to evaluate the potential cost-effectiveness of two smoking cessation approaches: the current basic smoking cessation program consisting of screening for tobacco use, advice, and referral; and a best practice smoking cessation program that includes the current basic program with the addition of pharmacological therapy, counseling, and follow-up. A Markov model was constructed that followed 65-year-old smokers with cancer over a lifetime horizon. Transition probabilities and mortality estimates were obtained from the published literature. Costs were obtained from standard costing sources in Ontario and reports. Probabilistic and deterministic sensitivity analyses were conducted to address parameter uncertainties. For smokers with cancer, the best practice smoking cessation program was more effective and more costly than the basic smoking cessation program. The incremental cost-effectiveness ratio of the best practice smoking cessation program compared to the basic smoking cessation program was $3367 per QALY gained and$5050 per LY gained for males, and $2050 per QALY gained and$4100 per LY gained for females. Results were most sensitive to the hazard ratio of mortality for former and current smokers, the probability of quitting smoking through participation in the program and smoking-attributable costs. The study results suggested that a best practice smoking cessation program could be a cost-effective option. These findings can support and guide implementation of smoking cessation programs

PCN162 The Cost-Effectiveness of Second-Line Crizotinib in Eml4-Alk Rearranged Advanced Non-Small Cell Lung Cancer

Background: Snoring / sleep apnea are potentially life threatening breathing occurs during sleep. Little attention is being giving to this clinical condition. Objective: To determine the prevalence of snoring and risk factors associated with obstructive sleep apnea (OSA) among adults workers in two local governments of state, Nigeria Methodology: A cross - sectional survey of 121 young adult and adults working in two local governments of Ekiti state, south western Nigeria was carried out. A self administered questionnaire that was incorporated with Epworth Sleepiness Scale and Berlin Score was used to collect data on socio-demographic characteristics, information related to snoring, sleep related problems and their anthropometric. The Body Mass Index (BMI) and blood pressure of each participant were also measured. Results: Snoring was reported in forty nine (40.5%) of the participants. Their age ranges from 23 to 65 years, mean of 43.89 ± 8.53 SD. The proportion of males and Berlin score (high risk) were significantly (p < 0.001) higher among snores than non regression found sex (OR=7.791, 95% CI =2.971- 20.429), Berlin Score (high risk) (OR= 8.642, 95% CI= 3.159 - 23.639) as significant (P< 0.001) independent risk factors for OSA. Excessive day time sleepiness as determined by ESS score of the participants. Conclusion: The overall prevalence of snoring in this study was 40.5%. Snoring was found to increase with age, body mass index, male sex and those with high risk for Berlin score with high risk of developing Obstructive sleep apne

The clinical effectiveness of different surveillance strategies to prevent colorectal cancer in people with intermediate-grade colorectal adenomas: a retrospective cohort analysis, and psychological and economic evaluations

Background: The UK guideline recommends 3-yearly surveillance for patients with intermediate-risk (IR) adenomas. No study has examined whether or not this group has heterogeneity in surveillance needs. Objectives To examine the effect of surveillance on colorectal cancer (CRC) incidence; assess heterogeneity in risk; and identify the optimum frequency of surveillance, the psychological impact of surveillance, and the cost-effectiveness of alternative follow-up strategies. Design: Retrospective multicentre cohort study. Setting: Routine endoscopy and pathology data from 17 UK hospitals (n = 11,944), and a screening data set comprising three pooled cohorts (n = 2352), followed up using cancer registries. Subjects: Patients with IR adenoma(s) (three or four small adenomas or one or two large adenomas). Primary outcomes: Advanced adenoma (AA) and CRC detected at follow-up visits, and CRC incidence after baseline and first follow-up. Methods: The effects of surveillance on long-term CRC incidence and of interval length on findings at follow-up were examined using proportional hazards and logistic regression, adjusting for patient, procedural and polyp characteristics. Lower-intermediate-risk (LIR) subgroups and higher-intermediate-risk (HIR) subgroups were defined, based on predictors of CRC risk. A model-based cost–utility analysis compared 13 surveillance strategies. Between-group analyses of variance were used to test for differences in bowel cancer worry between screening outcome groups (n = 35,700). A limitation of using routine hospital data is the potential for missed examinations and underestimation of the effect of interval and surveillance. Results: In the hospital data set, 168 CRCs occurred during 81,442 person-years (pys) of follow-up [206 per 100,000 pys, 95% confidence interval (CI) 177 to 240 pys]. One surveillance significantly lowered CRC incidence, both overall [hazard ratio (HR) 0.51, 95% CI 0.34 to 0.77] and in the HIR subgroup (n = 9265; HR 0.50, 95% CI 0.34 to 0.76). In the LIR subgroup (n = 2679) the benefit of surveillance was less clear (HR 0.62, 95% CI 0.16 to 2.43). Additional surveillance lowered CRC risk in the HIR subgroup by a further 15% (HR 0.36, 95% CI 0.20 to 0.62). The odds of detecting AA and CRC at first follow-up (FUV1) increased by 18% [odds ratio (OR) 1.18, 95% CI 1.12 to 1.24] and 32% (OR 1.32, 95% CI 1.20 to 1.46) per year increase in interval, respectively, and the odds of advanced neoplasia at second follow-up increased by 22% (OR 1.22, 95% CI 1.09 to 1.36), after adjustment. Detection rates of AA and CRC remained below 10% and 1%, respectively, with intervals to 3 years. In the screening data set, 32 CRCs occurred during 25,745 pys of follow-up (124 per 100,000 pys, 95% CI 88 to 176 pys). One follow-up conferred a significant 73% reduction in CRC incidence (HR 0.27, 95% CI 0.10 to 0.71). Owing to the small number of end points in this data set, no other outcome was significant. Although post-screening bowel cancer worry was higher in people who were offered surveillance, worry was due to polyp detection rather than surveillance. The economic evaluation, using data from the hospital data set, suggested that 3-yearly colonoscopic surveillance without an age cut-off would produce the greatest health gain. Conclusions: A single surveillance benefited all IR patients by lowering their CRC risk. We identified a higher-risk subgroup that benefited from further surveillance, and a lower-risk subgroup that may require only one follow-up. A surveillance interval of 3 years seems suitable for most IR patients. These findings should be validated in other studies to confirm whether or not one surveillance visit provides adequate protection for the lower-risk subgroup of intermediate-risk patients

Is Meta-Analysis for Utility Values Appropriate Given the Potential Impact Different Elicitation Methods Have on Values?

A growing number of published articles report estimates from meta-analysis or meta-regression on health state utility values (HSUVs), with a view to providing input into decision-analytic models. Pooling HSUVs is problematic because of the fact that different valuation methods and different preference-based measures (PBMs) can generate different values on exactly the same clinical health state. Existing meta-analyses of HSUVs are characterised by high levels of heterogeneity, and meta-regressions have identified significant (and substantial) impacts arising from the elicitation method used. The use of meta-regression with few utility values and inclusion criteria that extend beyond the required utility value has not helped. There is the potential to explore greater use of mapping between different PBMs and valuation methods prior to data synthesis, which could support greater use of pooling values. Researchers wishing to populate decision-analytic models have a responsibility to incorporate all high-quality evidence available. In relation to HSUVs, greater understanding of the differences between different methods and greater consistency of methodology is required before this can be achieved