Preliminary estimates of the economic implications of addiction in the United Arab Emirates.

This study aimed to provide preliminary estimates of the economic implications of addiction in the United Arab Emirates (UAE). Local and international data sources were used to derive estimates of substancerelated healthcare costs, lost productivity and criminal behaviour. From an estimated population of 8.26 million: ~1.47 million used tobacco (20.5% of adults); 380 085 used cannabis (> 5%); 14 077 used alcohol in a harmful manner (0.2%); and 1408 used opiates (0.02%). The cost of addiction was estimated at US$ 5.47 billion in 2012, equivalent to 1.4% of gross domestic product. Productivity costs were the largest contributor at US$ 4.79 billion (88%) followed by criminal behaviour at US$ 0.65 billion (12%). There were no data to estimate cost of: treating tobacco-related diseases, community education and prevention efforts, or social disharmony. Current data collection efforts are limited in their capacity to fully inform an appropriate response to addiction in the UAE. Resources are required to improve indicators of drug use, monitor harm and evaluate treatment.

The surgical aspects of Role 2 Afloat.

The current configuration of the surgical component of the Role 2 Afloat team is described, including an outline of the equipment available. The lessons learned from a recent exercise, where a Role 2 Afloat team was deployed on RFA CARDIGAN BAY are outlined and expanded, emphasising the difficulties of providing damage control surgery in the maritime environment.

Casemix in the Islamic Republic of Iran: current knowledge and attitudes of health care staff.

Casemix is a tool that classifies patients according to their clinical similarity and the homogeneity of resources required. A descriptive study was conducted to assess the level of knowledge and attitude toward the casemix-based funding system among staff working in the Iranian Social Security Organization in Tehran. The survey showed that knowledge of casemix and diagnosis-related groups (DRG) was poor among the study group and any attempt to implement the casemix system--which about three-quarters of high-level staff had never heard of--would be likely to fail. This highlights the necessity for creating awareness of the casemix and DRG systems among the hospital staff before any action takes place.

A cost-effectiveness analysis of heroin detoxification methods in the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD).

This economic evaluation was part of the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD) project. Data from four trials of heroin detoxification methods, involving 365 participants, were pooled to enable a comprehensive comparison of the cost-effectiveness of five inpatient and outpatient detoxification methods. This study took the perspective of the treatment provider in assessing resource use and costs. Two short-term outcome measures were used-achievement of an initial 7-day period of abstinence, and entry into ongoing post-detoxification treatment. The mean costs of the various detoxification methods ranged widely, from AUD 491 dollars(buprenorphine-based outpatient); to AUD 605 dollars for conventional outpatient; AUD 1404 dollars for conventional inpatient; AUD 1990 dollars for rapid detoxification under sedation; and to AUD 2689 dollars for anaesthesia per episode. An incremental cost-effectiveness analysis was carried out using conventional outpatient detoxification as the base comparator. The buprenorphine-based outpatient detoxification method was found to be the most cost-effective method overall, and rapid opioid detoxification under sedation was the most cost-effective inpatient method.

General practitioners' role in preventive medicine: scenario analysis using smoking as a case study.

AIM: It is the purpose of this paper to develop a model which may be used in conjunction with scenario analysis to evaluate strategies which are available to assist the general practitioner (GP) in reducing smoking behaviour among their patients. DESIGN: The scenario analysis uses a four-step procedure which involves identifying opportunities for detection, intervention and efficacy, and assigning probabilities to outcome to enable a range of prevention strategies to be examined in both isolation and in combination. SETTING AND PARTICIPANTS: This study deals specifically with Australian general practice and the model is derived by using information for a smoker visiting their GP within a 6-month period together with empirical evidence on the rates of detection, intervention and efficacy. MEASUREMENTS: The outcome measures, which are evaluated in terms of marginal effectiveness, include the number of smoking patients detected, the number of smoking patients offered an intervention, the number of smoker patients who quit as a result of the intervention and the additional years of life saved due to an intervention. FINDINGS. The most significant indicator for reducing smoking rates among patients is improving the efficacy of interventions. The results also suggest that although improvements in the rate of GP detection of patients' smoking status have a potentially greater effect on quit rates than increasing intervention levels, increasing both detection and intervention levels had a greater effect than each strategy alone. DISCUSSION: : General practitioners have an important role to play in preventive medicine. The knowledge, skill and attitude of practitioners toward smoking are significant, and they can be the prime motivators is persuading their patients to stop smoking. Detection, intervention and efficacious strategies are all key elements in achieving this result.

Smoking by adolescents: three years later, there's even larger revenue but little for prevention.

This research aimed to determine whether, between 1990 and 1993, there were any changes in the government revenue gained from sale of cigarettes to minors and the proportion of this revenue spent on attempting to prevent the uptake of this habit by adolescents. The methodology is consistent with the 1990 study, although some revisions have been necessary. From our analysis, it is estimated that state revenue from under-age smoking increased 97% from $9.37 million in 1990 to $18.45 million in 1993. State expenditure on anti-smoking campaigns (for the entire population) increased 24% from $9.47 million in 1990 to an estimated $11.75 million in 1993. When this expenditure is converted to a relative amount, relative state expenditure per under-age smoker fell an estimated 10%, from $4.40 in 1990 to $3.98 in 1993. This is equivalent to approximately 7.7% and 5.1%, in 1990 and 1993 respectively, of state revenue from cigarette smoking by those under the legal purchase age being spent on discouraging adolescents from taking up this habit. These results suggest a growing inequity in the expenditure on anti-smoking activities compared to revenues received from sales to minors.

A cost-benefit analysis of the average smoker: a government perspective.

The aim of this paper was to compare the benefit and costs of cigarette smoking from the government's perspective during a one-year period. This was undertaken by estimating, among other things, the publicly financed health care expenditure attributable to smoking and comparing it with tobacco taxes paid by smokers. This comparison of benefits and costs may provide a yardstick from which to measure the relative worth (in financial terms) an average smoker is to the government, an assessment that may be important when assessing health priorities and any level of commitment to reducing smoking rates. It is estimated that in 1989-90 an average smoker cost the government $203.57, while benefits received totalled an average of $620.56 in the same year. If the government were serious about addressing cigarette smoking as a primary health objective its efforts would portray this. The results of this analysis suggest that the objective of raising revenue from smoking is more of a priority than reducing smoking rates.

Smoking by adolescents: large revenue but little for prevention.

The purpose of this paper is to report on the government revenue gained from the sale of cigarettes to minors and the proportion of this revenue that is spent on attempting to prevent adolescents from taking up this habit. Prevalence of smoking by minors was extrapolated for the individual states using Australian prevalence data; estimates of annual cigarette consumption were coupled with the respective cost of cigarettes in each state to derive an estimate of the total revenue accumulating from cigarette consumption by minors. From our analysis, approximately 211,000 Australian children under the legal age to purchase cigarettes consumed approximately 11.5 million packets of cigarettes in 1990. The estimated tax revenues to the federal and state governments from these sales were $8.42 million and $12.78 million respectively. While the average state revenue from cigarette consumption by minors during 1990 was just over $60 per under-age smoker, only $0.11 per under-age smoker was spent on anti-smoking campaigns in 1990. This is equivalent to approximately 0.002 per cent of state revenue from cigarette smoking by those under the legal purchase age being spent on discouraging adolescents from taking up this habit. Clearly, there is an inequitable expenditure on antismoking activities, given the enormous resources obtained from sales to minors.