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

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

User participation in main canal governance

In The 4th Asian Regional Conference and 10th International Seminar on Participatory Irrigation Management (PIM), Teheran, Iran, 2-5 May 200