The cost effectiveness of pharmacological smoking cessation therapies in developing countries: a case study in the Seychelles

OBJECTIVE: To examine the incremental cost effectiveness of the five first line pharmacological smoking cessation therapies in the Seychelles and other developing countries. DESIGN: A Markov chain cohort simulation. SUBJECTS: Two simulated cohorts of smokers: (1) a reference cohort given physician counselling only; (2) a treatment cohort given counselling plus cessation therapy. INTERVENTION: Addition of each of the five pharmacological cessation therapies to physician provided smoking cessation counselling. MAIN OUTCOME MEASURES: Cost per life-year saved (LYS) associated with the five pharmacotherapies. Effectiveness expressed as odds ratios for quitting associated with pharmacotherapies. Costs based on the additional physician time required and retail prices of the medications. RESULTS: Based on prices for currently available generic medications on the global market, the incremental cost per LYS for a 45 year old in the Seychelles was 599 US dollars for gum and 227 dollars for bupropion. Assuming US treatment prices as a conservative estimate, the incremental cost per LYS was significantly higher, though still favourable in comparison to other common medical interventions: 3712 dollars for nicotine gum, 1982 dollars for nicotine patch, 4597 dollars for nicotine spray, 4291 dollars for nicotine inhaler, and 1324 dollars for bupropion. Cost per LYS increased significantly upon application of higher discount rates, which may be used to reflect relatively high opportunity costs for health expenditures in developing countries with highly constrained resources and high overall mortality. CONCLUSION: Pharmacological cessation therapy can be highly cost effective as compared to other common medical interventions in low mortality, middle income countries, particularly if medications can be procured at low prices.

Treating tobacco use and dependence in clinical practice.

Physicians are in a unique position to advise smokers to quit by the ability to integrate the various aspects of nicotine dependence. This review provides an overview of the intervention strategies for smokers presented in a primary care setting. The strategies that are used for smoking cessation counselling differ according to the patient's readiness to quit. For smokers who do not intend to give up smoking, physicians should inform about tobacco use and the benefits of cessation. For smokers who are dissonant, physicians should use motivational strategies, such as discussing the barriers to successful cessation and their solutions. For smokers who are ready to quit, the physician should show strong support, help set a date to quit, prescribe pharmaceutical therapies for nicotine dependence, such as nicotine replacement therapy (i.e., gum, transdermal patch, nasal spray, mouth inhaler, lozenges, and micro and sublingual tablets) and/or bupropion (an atypical antidepressant thought to work by blocking the neural re-uptake of dopamine and/or noradrenaline), with instructions for use, and suggest behavioural strategies to prevent relapse. The efficacy of all of these pharmacotherapies is comparable, roughly doubling the cessation rates over control conditions.

Example of Monte Carlo uncertainty assessment in the field of radionuclide metrology

This chapter presents possible uses and examples of Monte Carlo methods for the evaluation of uncertainties in the field of radionuclide metrology. The method is already well documented in GUM supplement 1, but here we present a more restrictive approach, where the quantities of interest calculated by the Monte Carlo method are estimators of the expectation and standard deviation of the measurand, and the Monte Carlo method is used to propagate the uncertainties of the input parameters through the measurement model. This approach is illustrated by an example of the activity calibration of a 103Pd source by liquid scintillation counting and the calculation of a linear regression on experimental data points. An electronic supplement presents some algorithms which may be used to generate random numbers with various statistical distributions, for the implementation of this Monte Carlo calculation method.

Al-Bīrūnī's Kitāb Sānk and Kitāb Pātanğal:A Historical and Textual Study

The historical pole of this research distinguishes differing historical and cultural contexts in which the scholar al-Bïrûnî evolved. Between the years 973 and 1017, he lived in Khwarezm (Kät and JürjänTya), Ray, and Jürjän. He also dwelt in Kabul and Ghazna, both situated on a passage between Persia and India, and travelled to some parts of early medieval India between the years 1017 and 1030. Evidence pointing to him having made actual direct observations beyond the abode of Islam remains scanty. According to his writings, only five locales emerge as having been visited by him, all situated in today's Afghanistan and Pakistan. When al-BTrunl visited these places, he encountered the society of the Indian Shähis, who followed a form of Brahmanism. Al-Bïrûnï's knowledge of Sanskrit was the result of a long process that lasted at least 30 years (1000-1030). In order to reach the level of Sanskrit that enabled him to translate several works from Sanskrit into Arabic, he needed to work with literate people well-versed in Sanskrit, who may also have had some comprehension of Arabic, and/or Persian. The textual pole of this dissertation examines the question of the relationship between al- Bïrûnï's Arabic Kitab Sank and Kitäb Pätangal - two works related to Sämkhya-Yoga - and their possible Sanskrit sources. A philological survey based on these Arabic translations and on Sämkhya-Yoga Sanskrit literature highlights that al-Bïrûnï's translations, both, are related to the classical phase in the development of these two Indian philosophical systems. Despite the early spread of Yoga and Sämkhya ideas through Sanskrit literature, it seems that between the early 11th and 16th centuries they lost vitality amongst Indian scholars. Therefore, al-Bïrûnï's translation of works related to these specific Indian philosophies in the early 11th century CE deserves attention. The second pole of this study also demonstrates that al-BTrünl's hermeneutics played an important part in his transmission of these two Indian schools of thought, as he highly transformed his source in both form and substance. This dissertation considers the question of the relationship between al-Bïrûnï's Arabic translations and their possible Sanskrit sources from the viewpoint of Translation Studies; which makes it possible to point out potential candidates for being al-Bïrûnï's original Sanskrit sources with some confidence. Overall, the Kitäb Sank and the Kitäb Pätangal represent original works of Sämkhya and Yoga, as viewed and transmitted by a Perso-Muslim scholar, rather than pure translations of Sanskrit work.