Cost effectiveness of different cervical screening strategies in Islamic Republic of Iran: a middle-income country with a low incidence rate of cervical cancer

Objective: Invasive cervical cancer (ICC) is the fourth most common cancer among women worldwide. Cervical screening programs have reduced the incidence and mortality rates of ICC. We studied the cost-effectiveness of different cervical screening strategies in the Islamic Republic of Iran, a Muslim country with a low incidence rate of ICC. Methods: We constructed an 11-state Markov model, in which the parameters included regression and progression probabilities, test characteristics, costs, and utilities; these were extracted from primary data and the literature. Our strategies included Pap smear screening and human papillomavirus (HPV) DNA testing plus Pap smear triaging with different starting ages and screening intervals. Model outcomes included lifetime costs, life years gained, quality-adjusted life years (QALY), and incremental cost-effectiveness ratios (ICERs). One-way sensitivity analysis was performed to examine the stability of the results. Results: We found that the prevented mortalities for the 11 strategies compared with no screening varied from 26% to 64%. The most cost-effective strategy was HPV screening, starting at age 35 years and repeated every 10 years. The ICER of this strategy was $8,875 per QALY compared with no screening. We found that screening at 5-year intervals was also cost-effective based on GDP per capita in Iran. Conclusion: We recommend organized cervical screening with HPV DNA testing for women in Iran, beginning at age 35 and repeated every 10 or 5 years. The results of this study could be generalized to other countries with low incidence rates of cervical cancer

Formulation and Evaluation of Rose Oil Nanoemulsion %0.1 on Skin Properties

Introduction: One of the causes of the skin drying is lack of oil secretion by sebaceous glands in skin. Then this can make skin sensitive to environmental factors and some substances. Ancient Iranians have used rose water for washing the face and increase moister of skin. Nano-emulgel Due to its high stability, biocompatibility and proper solubility in water are considered as good carriers for targeted drug delivery, and have a good potential for drug delivery because they have the properties of nanoparticles of colloids and hydrogels simultaneously. In this research, effects of rose oil nanoemulgel %0.1 are evaluated on the normal and dried skin. Methods and Results: Different formulations of rose oil were evaluated using suitable surfactants. Then the best ratio of nano-emulgel Red flowers and sustainability criteria were determined. Rose oil components were identified by GC/MS. Clinical studies were conducted for an eight-week on 60 healthy volunteers in two groups. A nano-emulgel %0.1 rose oils and other non-essential emulgel with the same basic materials were used and the amount of sebum secretion, melanin, skin redness, hydration and elasticity of the skin and also complications were determined. Quantitative data analysis was done by using Chi-square test and P≤0.05 were considered significant. The results have demonstrated the effectiveness of the rose oils in skin hydration. Two groups with other characteristics such as the skin secretion of sebum, elasticity, pigmentation , and redness have shown similar effects. However, both groups did not show any complications. Conclusions: In this study, the main ingredient of essential oil is alcohol. The most important terpene alcohols are, 31% Nonadecane, 38% Citronellol, 23% Linalool , and 17% Heneicosane. The good effectiveness of Rose oil on increasing of skin moisture is the appropriate treatment of skin drying

Liquisolid compact: Effect of Propylene glycol and Tween80 on atorvastatin release from tablet matrices containing Eudragit RSPO

Introduction: Liquisolid system has been used to increase the dissolution rate of hydrophobic drugs. Since drug solubility play an important role in drug release profile, using appropriate solvent can lead the system to become sustain release. The aim of this study was to investigate the effect of different liquid vehicles and Eudragit RSPO on release characteristics of atorvastatin as a hydrophobic drug. Methods and Results: Several Liquisolid compacts with Propylene glycol and tween80 with different drug solvent ratio was prepared. The ratio of the carrier material (Eudragit RSPO: microcrystalline cellulose, (60:40)), for coating material (silica) was 2 in all formulations. To evaluate any interaction between atorvastatin and the other components, the differential scanning calorimeter (DSC) and Fourier transform infrared spectroscopy (FTIR) was used. Atorvastatin Liquisolid compacts containing Propylene glycol and tween80 as liquid vehicle increased dissolution rate of drug from 23.75±0.33 (in conventional matrix formulation) to 38.66±1.77 and 99.95±4.2 respectively, in first 480 minute. By increasing the ratio of tween80 to drug from 1:1 to 4:1 reduced drug retardation was seen, consequently the release percentage increased from 60.50±3.1 to 99.95±4.2. This was contrary to propylene glycol drug formulation. The resultant difference in effect of formulations was probably due to more solubility of atorvastatin in tween80 (26.77 g/100ml) in comparison to Propylene glycol (11.65 g/100ml). It was observed that a slight change on carrier (55.66 increased to 57.54%) and drug percentage (3.15% decreased to 2.59%) in formulation with Tween80:drug ratio (4:1), presented more retardation effect so that release percentage decreased from 99.95±4.2 to 75.92± 2.20. All formulations had hardness and friability between (35.6±0.57 - 43.4±1.14) N and (0.67% - 1.3%), respectively. The DSC, FTIR and X-ray evaluations revealed no interaction between drug and excipients.  Conclusions: The liquisolid compacts with the suitable carrier can be promising technique to sustain release drugs, in addition, type of nonvolatile solvent has an important effect on liquisolid release profile

Cost-effectiveness of 11 different strategies for cervical screening.

<p>Strategies standing on the curve are dominant strategies, indicating that they cost less and had more effect. Strategies located out of the curve are dominated strategies, i.e. their costs were much higher than their effects.</p

Incidence, mortality, cost, effectiveness, ICER, and undiscounted ICER of 11 strategies compared with no screening strategy.

<p>Incidence, mortality, cost, effectiveness, ICER, and undiscounted ICER of 11 strategies compared with no screening strategy.</p

The most cost-effective strategies (CES) based on different calculation methods.

<p>The cost-effectiveness of 11 strategies were estimated with different methods. Effectiveness was measured with QALY, LYG, and undiscounted QALY.</p