A large proportion of shisha smokers viewed shisha as a safer alternative to cigarettes, yet they admitted to intending to quit. These findings underscore the need to design educational interventions and awareness campaigns as well as impose stringent laws on waterpipe smoking in public places in Qatar.

Most ACS patients were prescribed antiplatelets, β-blockers and statins, but the use of ACEIs or ARBs was suboptimal. Strategies are needed to enhance ACEI or ARB prescribing, especially for high risk patients who would have the greatest therapeutic benefit from these drugs.

Background: The interest in the economic evaluations of “prophylactic” systemic antifungals is on the rise, especially with the emergence of newer expensive agents for prophylaxis of invasive fungal infections (IFI). Decision analytic modeling is a systematic approach that has become integral in the economic evaluation process for the purpose of simplifying the decision making. This systematic review aims to identify the prevalence of decision-analytic modeling in the pharmacoeconomic literature regarding prophylactic therapies for systemic fungal infections, and to identify variations in model designs used along with defining specific areas of strengths and weaknesses. Method: A systematic literature search was conducted using the e-databases Pubmed, Medline, Embase, Economic Evaluation, Econlit, and Cochrane to obtain all model-based economic evaluations of antifungal agents. Search terms were under three categories: (i) therapy (antifungal agent [Mesh] OR Prophylaxis); (ii) disease (mycosis [Mesh] OR fungal disease [Mesh] OR invasive OR systemic); and (iii) research design (economics [Mesh] OR decision analysis [Mesh] OR costs and cost analysis [Mesh]). Publications were included if they were journal articles, full text publications, human studies, English language. Study articles were excluded if they were reviews, studying topical antifungal, non-invasive infections, or non-economic models. Journal article inclusion and data extraction, via a data collection form, were conducted twice, each by different researcher. Results: Out of 841 citations, only 19 articles were eligible for inclusion. Most of studies were relatively recent, conducted in 2008–2013. Seventeen of them used sources of clinical data from pooled randomized control trials. Evaluations were mostly in USA (7), the remaining in Australia, Canada, Spain, The Netherland, Korea, Greece, France, Germany, and Switzerland (1–2 articles each). All articles utilized the cost-effectiveness method using decision tree models; including 10 using Markov modeling for simulating future use of medications. This was, as appropriate, associated with discounting type of cost adjustment. Drug comparisons in included studies (27/29) were mostly between an old cheaper antifungals and more expensive newer ones. The 19 articles incorporated 15 studies with cost per life year gained measure, six with cost per IFI avoided, one with cost per Quality Adjusted Life Year, and four included cost saving per patient measure. Most important, is that same clinical measures were defined differently in different studies. Most studies reported dominance state, the majority were in favor of posaconazole (9 out of 12), and five studies required incremental cost effectiveness ratio analysis. Only direct medical costs were considered in studies despite that six articles had social perspectives instead of the hospital perspective. All articles had adjusted costs either for inflation (9/19 articles) or discounting. Fourteen articles used only one way sensitivity analysis while few used a combination with multivariate (2) or scenario (3) analyses. Conclusion: Decision making in relation to prophylactic antifungals is not complex, including the economic considerations; whereby straightforward therapy dominance status was demonstrated in the majority of studies. Most important, is that the literature evidence in relation the cost-effectiveness of systematic antifungals is not cumulative in nature, which is due to that same outcomes are defined differently in studies. This also meant that literature economic models are incomparable and not generalizable since different decision makers appear to be interested in different outcomes, including for the same antifungal agent. Studies are limited by not considering cost of side effects and alternative therapy options. Further studies are needed to compare among the newer more expensive agents, where evidence is lacking. Also, studies should be enhanced by better adhering to guidelines in relation to standardized definitions of health states, enabling a cumulative evidence generation and generalizability of findings.

reported in favor of OACDs. Decision analytic modeling was used in the majority of studies, mostly constituting Markov modeling. Sensitivity analyses were conducted in most studies, constituting one-way sensitivity analysis. The types of cancers, where the effect of OACDs was studied, were the metastatic renal carcinoma, gastrointestinal tumors, colon cancer, chronic myeloid leukemia and non-small cell lung cancer. Most included articles were published during the last seven years. Most studies were only conducted in the UK, US and Europe. ConClusions: This is first systematic review of the economic methods used in the evaluation of OACDs. Most important, is that despite the higher acquisition cost, OACDs were demonstrated to be mostly superior over the parenteral alternatives. The pharmacoeconomics studies are difficult to generalize, whereby published economic evaluations are locally specific, especially for the purpose of practical interpretation.

Background: Around 14.1 million new cancer cases and 8.2 million deaths caused by cancer were reported in 2012, expected to rise up to 22 million within the next 2 decades. The parenteral route (intravenous dosage form) has been the most common administration route for chemotherapeutic agents, which is associated with the need for hospitalization and a range of significant adverse drug reaction. A new generation of chemotherapies that is orally administered has been introduced to practices as a superior and more efficient therapeutic alternative. Oral anticancer drugs (OACDs) have shown to be eliminating the need for hospitalization, decreasing the rate of adverse drug reactions and, ultimately, improving patients' quality of life. Economically, this translates into reduction in inpatient hospitalization costs, including several of the associated costs, such as the cost of treating side effects. A disadvantage of OACDs however, is the increased acquisition costs as compared to those for the intravenously administered alternatives. This resulted into resistance to include OACDs by several international insurance schemes and drug formulary practices, including in Qatar. Objectives: The current project sought to analyze the medical literature in relation to published economic evaluations (pharmacoeconomics) of OACDs, especially as compared to the parenteral alternatives. This will identify the decision analytic modeling conducted as well as the variety of methods used. Strengths and weaknesses of study designs will be determined, including gaps in knowledge. Methodology: A thematic systematic review was conducted using the search engines: PubMed, Medline, EconLit, Embase and Economic Evaluation Database. The following 3 categories were considered: (i) therapy (chemotherapy [Mesh]); (ii) dosage form (oral [Mesh]); and (iii) research design (economics [Mesh] OR cost-benefit analysis [Mesh]). These included full-text, English articles incorporating comparative economic evaluations of oral chemotherapies. Excluded studies were: non-comparative, non-economic based models, of secondary indications (not cancer), and/or reviews. This process was followed by two stages of manual exclusion; based on title/abstract content and, then, the full-text article content. A data extraction form was developed and pilot tested for the purpose of data collection. Article inclusion and data collection was conducted twice, each by a different investigator. Included articles were finally summarized according to methodological themes of interest. Results: A total of 235 records were identified. After screening and removing duplicates, only 18 studies were deemed eligible study inclusion. It was found that the pharmacoeconomics evaluations were mostly of cost-utility analyses (13 out of 18), measuring cost per quality adjusted life years (QALY) gained, and from the payer perspective (15 out of 18). Primary sources of clinical and economic data were randomized clinical trials, expert panels and medical charts. Other sources included medicine databases, reimbursement schedules, drug policies and price lists, treatment guidelines, case reports and patient interviews. In 13 out of 18 cases, dominance status was reported in favor of OACDs, in relation to cost and/or clinical effect. Decision analytic modeling was used in the majority of studies, mostly constituting Markov modeling for the simulation of life long use of drugs. Sensitivity analyses were conducted in most studies, mostly constituting one-way sensitivity analysis to ensure robustness of study results. The types of cancers, where the effect of OACDs was studied, were the metastatic renal carcinoma, gastrointestinal tumors, colon cancer, chronic myeloid leukemia and non-small cell lung cancer. Most included articles were published during the last seven years. Most studies were conducted in the UK, US and Europe, while none were conducted in Australia or the Middle East. Conclusion: This is first systematic review of the economic methods used in the evaluation of OACDs. There seems to be a recent increasing interest of this type of research, whereby the QALYs measurement is of priority for the decision making in relation to the comparative value of OACDs in practices. Most important, is that despite the higher acquisition cost, OACDs were demonstrated to be mostly superior over the parenteral alternatives. Furthermore, the decision analytic modeling, mostly constituting Markov modeling, is valued and enables a structured decision analyses of therapies. The pharmacoeconomics research is difficult to generalize, whereby published economic evaluations are locally specific, especially for the purpose of practical interpretation. The current review of literature proposes valuable methods for the local Qatari implementation and guidance of decision makers. This is most relevant to National Center for Cancer Care & Research (NCCCR), which is the only tertiary service provider of cancer therapy in Qatar, where confusion in relation to the use of oral chemotherapies exists, particularly the therapies vinorelbine and capacitabine.

Objectives: Lung cancer is the most common type of cancer over the world, from which 80-85% is non-small cell lung cancer (NSCLC). Erlotinib has been approved by FDA for first-line therapy in EGFR-mutations positive NSCLC. However the high price of drug created a large barrier in practice especially in Vietnam. This study aims to evaluate the cost -effectiveness of erlotinib versus current chemotherapy (gemcitabine/carboplatin -GC) in first-line therapy of EGFR -mutations positive NSCLC from Vietnamese healthcare payers' perspective. MethOds: A three-state Markov model has been constructed to predict expected costs and outcomes for each regimen. Only medical direct cost including cost for drug and medical services has been evaluated due to the healthcare payers' perspective. Data of effectiveness has been retrieved from the clinical trial OPTIMAL -CTONG 0802, data of treatment cost has been estimated based on the treatment guideline of Ministry of Health of Vietnam. One-way deterministic sensitivity analysis has been conducted to evaluate the sensitivity of model. Results: It has been shown that within life-time horizon, erlotinib regimen required approximately 601 million VND more than the GC regimen (884 million vs 283 million VND, respectively) with 0.75 QALY gained (1.51 vs 0.76; respectively). The ICER/QALY was accounted for 801.3 million VND per QALY gained, which is lower than 3 times of WTP of Viet Nam. That means erlotinib was limited cost-effective compared with GC regimen in first-line therapy of advanced EGFR-mutations positive NSCLC from healthcare payers' perspective. One-way deterministic sensitivity analysis showed that the price of erlotinib, gemcitabin and carboplatin were the most influencing factors on the cost-effectiveness of erlotinib. cOnclusiOns: Erlotinib was limited cost-effectiveness compared with GC in first-line therapy of advanced EGFR-mutations positive NSCLC. The result revealed the necessity of supports from suppliers or heath insurance agencies to enhance cost-effectiveness of erlotinib in advanced NSCLC treatment.