Cancer research priorities for early diagnosis in Iran: Analyses based on Multiple-Attribute Decision Making Model

Introduction National comprehensive cancer control programs combat cancer through different measures, including primary prevention, early detection, treatment, and palliative and supportive care. Among the others, early detection programs seem to be a promising intervention and lead to lower cancer mortality. We define research priorities for the early detection of cancers in Iran. Methods We applied the multiple criteria decision-making (MCDM) tools using three key attributes, including "5-year prevalence", "mortality to incidence ration as severity of disease," and "economic burden," to ranked different cancers for research priorities. The priorities were ranked based on four scenarios based on the weighting of the attributes. We also used the differences in the 5-year survival between localized and advanced tumors as the effect of early detection and incorporated it as the decision rule into the priority-setting model. Results Gastric cancer and cancers of the brain and nervous system ranked first in all the proposed scenarios. The most and least 5-year survival differences between localized and advanced cancers were observed for the kidney (80.5%) and the brain (3.3%) cancers. The top 10 priorities for early cancer detection in Iran were gastric, prostate, breast, lung, colorectal, ovarian, kidney, bladder, and cervical cancers. Conclusion We used a quantitative method and demonstrated the priority areas for research in the early detection of cancer in Iran. Researchers and government may use these results to optimize their research strategies for cancer prevention in Iran.

Health Technology Assessment of CAD/CAM in Dentistry

Introduction: Computer-Aided Design and Computer-Aided Manufacturing (CAD/CAM) are the latest achievements of Prosthodontics and Restorative Dentistry. The aim of this research is to help make appropriate decision whether to use this technology in Iran. Methods: Studies were included in this review that compared Dental CAD/CAM with conventional restorative methods in terms of safety, efficacy and cost-effectiveness using Cochrane Library, CRD and Pub med. Results were analyzed using qualitative methods. Results: Six articles were used. Different indices of effectiveness in two types of application were found through the studies. Total failure rate for dental inlays was obtained as 0, 2.6% in 3 studies during a 4-year period and 1.75% in a 7-year period. It was 0.53% and 3.61% in two studies for prosthesis. Five-year survival rate for dental inlays was obtained from 91.6% to 100% and for prosthesis 72.2% to 100% in two studies. In terms of cost-effectiveness ratio of this technique compared to traditional methods, using ceramics fabricated along with chair side CAD/CAM is higher than traditional method; thus using it provides higher cost-effectiveness ratio than restoration by gold. Conclusion: This technology seems to be safe and effective and if this application is performed by specialists in the field of prosthetics, it will have favorable results. Although this HTA study confirmed the cost effectiveness of the dental CAD/CAM, economic evaluation of the technology in Iran is recommended for the future

Health Technology Assessment of the Psychotherapy Effect on Prevention of Suicide and Self-Harm: A Rapid Review of Secondary Studies

Introduction: According to the World Health Organization (WHO) report, acute depression disorders are the second largest health problem in the world which can cause disability and imposes huge costs on individuals and societies. This study aims to investigate the effectiveness and cost-effectiveness of using psychotherapy in patients with depression for prevention of suicide and self harm commitment. Methods: Cochrane library (Issue 10, 2012) and CRD (Centre for Review and Dissemination) were searched using Mesh. Studies that compared psychotherapy with different alternative methods such as antidepressant drugs and used outcomes such as self-harm or suicide rates were included. Results: Eighteen articles were included in this review. Most of them showed that using psychotherapy as only suicide preventive method cannot be sufficiently effective, so that in the one of the included meta-analysis was shown that the effect of psychotherapy on suicide imagination and the risk of suicide were small. In terms of cost-effectiveness, it seems that MACT (Manual-assisted cognitive behavior therapy) is a cost-effective method in prevention of self-harm. Conclusion: Generally, it seems that using combination of therapeutic methods will increase the effectiveness of suicide and self-harm prevention methods