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      • Management of Precancerous Cervical Lesions in Iran: A Cost Minimizing Study

        Nahvijou, Azin,Sari, Ali Akbari,Zendehdel, Kazem,Marnani, Ahmad Barati Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.19

        Background: Cervical cancer is a common, preventable and manageable disease in women worldwide. Objectives: This study was conducted to determine the cost of follow-up for suspicious precancerous cervical lesions within a screening program using Pap smear or HPV DNA test through the decision tree. Materials and Methods: Patient follow-up processes were determined using standard guidelines and consultation with specialists to design a decision tree model. Costs of treatment in both public and private sectors were identified according to the national tariffs in 2010 and determined based on decision tree and provided services (visits to specialists, colposcopy, and conization) with two modalities: Pap smear and HPV DNA test. The number of patients and the mean cost of treatment in each sector were calculated. The prevalence of lesions and HPV were obtained from literature to estimate the cost of treatment for each woman in the population. Results: Follow-up costs were determined using seven processes for Pap smear and 11 processes for HPV DNA test. The total cost of using Pap smear and HPV DNA process for each woman in the population was 36.1$ and 174$ respectively. Conclusions: The follow-up process for patients with suspicious cervical lesions needs to be included in the existing screening program. HPV DNA test is currently more expensive than Pap smear, it is suggested that we manage precancerous cervical lesions with this latter test.

      • A Systematic Review of Economic Aspects of Cervical Cancer Screening Strategies Worldwide: Discrepancy between Economic Analysis and Policymaking

        Nahvijou, Azin,Hadji, Maryam,BaratiMarnani, Ahmad,Tourang, Fatemeh,NedaBayat, NedaBayat,Weiderpass, Elisabete,Daroudi, Rajabali,AkbariSari, Ali,Zendehdel, Kazem Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.19

        Background: Organized cervical screening has decreased the incidence of cervical cancer. However, screening strategies vary in different countries. Objectives: We performed a systematic review to evaluate the economic aspects of different screening methods. Materials and Methods: We searched databases and then data were abstracted from each study. We evaluated articles based on different types of screening tests as well as screening age and intervals, and using incremental cost effectiveness ratio via calculating quality adjusted life years (QALY), or life years gained (LYG) per cost. We compared the incremental cost-effectiveness ratio (ICER) of each study using GDP per capita. Furthermore, we compared national guidelines with recommendations of cost-effectiveness studies in different countries. Results: A total of 21 articles met our criteria, of which 19 studies showed that HPV DNA testing, 13 suggested an age of 30 years or more, and 10 papers concluded that at least a 5-year or longer interval were the most cost-effective strategies. In some countries, the national guidelines did not match the recommendations of the cost-effectiveness studies. Conclusions: HPV testing, starting at age 30 years or older and repeated at 5-year or longer intervals, is the most cost-effective strategy in any setting. Closer collaboration with health economists is required during guideline development.

      • Challenges to Promoting Population-Based Cancer Registration in Iran: a Workshop Report

        Hadji, Maryam,Nahvijou, Azin,Seddighi, Zahra,Beiki, Omid,Mohagheghi, Mohammad Ali,Mosavi-Jarrahi, Alireza,Marnani, Ahmad Barati,Zendehdel, Kazem Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.10

        In December 2011, the Cancer Research Centre of the Cancer Institute of Iran sponsored a 3-day workshop on "Cancer Registration Principle and Challenges in Iran", which convened cancer registry experts. The objectives of the workshop were: to introduce standard cancer registration, to review the policy and procedure of cancer registration in Iran, and to review the best practices in the cancer registries in Iran. Challenges to cancer registration were discussed and recommendations were developed. The workshop was evaluated by participants for better organization of subsequent workshops. The objective of publication of this report is that based on Cancer in 5 Continents, many low- or middle-income countries do not meet the criteria for a standard population-based cancer registry (PBCR); on the other hand cancer is the most important cause of mortality and the essential part of any cancer control program is the cancer registry. Therefore this report focuses on problems and challenges of PBCR and provides recommendations which might help other developing countries to decrease their PBCR defects.

      • Relationship between Spiritual Health and Quality of Life in Patients with Cancer

        Mohebbifar, Rafat,Pakpour, Amir H,Nahvijou, Azin,Sadeghi, Atefeh Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.16

        As the essence of health in humans, spiritual health is a fundamental concept for discussing chronic diseases such as cancer and a major approach for improving quality of life in patients is through creating meaningfulness and purpose. The present descriptive analytical study was conducted to assess the relationship between spiritual health and quality of life in 210 patients with cancer admitted to the Cancer Institute of Iran, selected through convenience sampling in 2014. Data were collected using Spiritual Health Questionnaire and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ). Patients' performance was assessed through the Karnofsky Performance Status Indicator and their cognitive status through the Mini-Mental State Examination (MMSE). Data were analyzed in SPSS-16 using descriptive statistics and stepwise linear regression. The results obtained reported the mean and standard deviation of the patients' spiritual health scoreas $78.4{\pm}16.1$ and the mean and standard deviation of their quality of life score as $58.1{\pm}18.7$. The stepwise linear regression analysis confirmed a positive and significant relationship between spiritual health and quality of life in patients with cancer (${\beta}$=0.688 and r=0.00). The results of the study show that spiritual health should be more emphasized and reinforced as a factor involved in improving quality of life in patients with cancer. Designing care therapies and spiritual interventions is a priority in the treatment of these patients.

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