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Background The scarcity of resources restricts healthcare financing decisions, affecting the population's health. Health technology assessment (HTA) balances restricted budgets with the best possible health outcomes. We aim to characterize the current status of HTA in Algeria and describe the future directions for HTA implementation according to the priorities set by local stakeholders. Methods Stakeholders from the public and private sectors responded to a policy survey about the current and preferred future status of HTA implementation in Algeria. The survey was administered during an online workshop and used a widely accepted international scorecard covering eight domains: capacity building, HTA financing, process and organizational structure, scope of HTA implementation, decision criteria, standardization of methodology, use of local data, and international collaboration. After that, one-on-one interviews with another local expert were conducted to validate and modify the draft recommendations. The interviewees were representatives from government agencies, hospitals, and pharmaceutical companies. Results Thirty-one experts filled out the HTA scorecard survey; most of them were from the public sector (74%). They highlighted that project-based HTA workshops or short courses were the most common form of HTA education in Algeria and recommended the establishment of postgraduate HTA training programs in the future to build sustainable capacities. They reported a lack of funding for HTA research and critical appraisal and recommended an increased public budget for HTA and the introduction of submission fees by manufacturers. There was consensus about the need for local HTA evidence generation in the future. Most of the experts advocated an explicit soft decision threshold. The interviewees further recommended using multi-criteria decision analysis in the short term. The application of quality indicators was believed to improve the reliability of the HTA process. Conclusion The results of our policy research delineate the gap between the current and preferred future status of HTA in Algeria based on insights from multiple stakeholders. The need to improve the educational HTA programs in Algeria, use local data in policy decisions, and increase funding for HTA were the most advocated recommendations.
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INTRODUCTION: Proper understanding of the prevalence and determinants of nicotine dependence is crucial for developing and implementing effective tobacco control interventions. The aim of the study was to identify the intrinsic and extrinsic barriers to smoking cessation, and to assess the association between nicotine dependence with demographic variables in Malaysia. METHODS: A cross-sectional survey based on the Challenges to Stopping Smoking Scale (CSS-21) and Fagerström test for nicotine dependence (FTND) was performed on smoking Malaysian citizens aged ≥18 years, from February to June 2021. RESULTS: A total of 1026 parents responded to the survey. As for the smoking dependence based on FTND, 39.1% suffered low-moderate dependence, while about 33.6% suffered moderate dependence. Only 1.8% suffered high dependence. Considering the barriers of quitting smoking based on CSS-21, the mean score of the intrinsic barriers domain was 5.7 ± 2.9, and for the extrinsic domain was 7.4 ± 4.0. The most common barrier reported in the intrinsic domain was the easy availability of cigarettes (69.8%), followed by experiencing withdrawal symptoms (68.5%). On the other hand, the most common barrier reported in the extrinsic domain was the belief in the capability of stopping smoking in the future (72.8%), followed by the fear of having side effects after stopping smoking (63.2%). Gender, race, education level, occupation, marital status, place of residence, and monthly income were also significantly associated with the FTND nicotine dependence category (all p<0.05). Pearson correlation analysis reported a positive association between intrinsic score (r=0.38), extrinsic score (r=0.43) and FTND score (all p<0.001). CONCLUSIONS: Barriers to stopping smoking should be taken into consideration in initiatives to decrease smoking-related mortality. Vulnerable populations that are susceptible to high nicotine dependence should be given particular attention.
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There has been less volume of literature focusing on the Immune-related Hematological Adverse Drug Events (Hem-irAEs) of Immune Checkpoint Inhibitors (ICPis) in cancer patients. Furthermore, there has been no consensus about the management of hematological toxicity from immunotherapy in the recently published practice guidelines by the European Society for Medical Oncology (ESMO). We conducted a systematic review of case reports/series to describe the diagnosis and management of potentially rare and unrecognized Hem-irAEs. We searched Medline, OVID, Web of Science for eligible articles. Data were extracted on patient characteristics, Hem-irAEs, and management strategies. We performed quality assessment using the Pierson-5 evaluation scheme and causality assessment using the Naranjo scale. Our search retrieved 49 articles that described 118 cases. The majority of patients had melanoma (57.6%) and lung cancer (26.3%). The most common Hem-irAEs reported with ICPis (such as nivolumab, ipilimumab, and pembrolizumab) were thrombocytopenia, hemolytic and aplastic anemias. Less reported adverse events included agranulocytosis and neutropenia. Steroids were commonly used to treat these adverse events with frequent success. Other used strategies included intravenous immunoglobulins (IVIG), rituximab, and transfusion of blood components. The findings of this review provide more insights into the diagnosis and management of the rarely reported Hem-irAEs of ICPis.
