Objective: In this work the cost-effectiveness of smoking cessation in Japan was investigated. Five groups of subjects, simulating cohorts wishing to quit smoking, were chosen as follows: (i) naturally quitting smoking, (ii) nicotine patch OTC medicine ( OTC patch), (iii) nicotine gum OTC medicine ( OTC gum), (iv) prescribed nicotine patch ( prescribed patch), and (v) prescribed bupropion.
Design: A Markov model study
Method: Using a Markov model, the cost per life-year saved associated with pharmacotherapy for quitting smoking cohorts of 30 · 40 · 50-year-old men and women was estimated. The expenses associated with smoking cessation were calculated based on either current retail prices of the medications in a community pharmacy practice or a fee schedule ; the costs and benefits were discounted by 3 % annually. Sensitivity analyses for the treatment effectiveness were performed.
Results: The incremental cost per life-year saved for the OTC patch method ranged from 518,826 yen to 652,282 yen for men and from 351,317 yen to 725,109 yen for women. For the case of the OTC gum the values were 871,442 yen to 1,205,142 yen for men and 592,558 to 1,282,263 yen for women. The prescribed patch values ranged from 504,373 yen to 603,371 yen for men and 340,734 yen to 685,626 yen for women. The corresponding values for prescribed bupropion were 562,564 yen to 670,768 yen for men and 379,960 yen to 763,283 yen for women. Sensitivity analyses indicated that changes in the treatment effectiveness had the strong influence on cost-effectiveness.
Conclusions: Smoking cessation utilising pharmacotherapy in Japan was found to be cost-effective in comparison with natural methods of quitting smoking. OTC patch and prescribed patch were the two most cost-effective treatments.

Although palliative sedation therapy (PST) is considered to alleviate intolerable and refractory symptoms in dying patients with advanced cancer, there have been few studies regarding the situation of tertiary cancer center. We conducted a retrospective survey of the medical records of the patients who died between April 2015 and March 2016 at the National Cancer Center Hospital in Japan. PST was conducted in 75 out of 431 patients (17.4%). The patient demographics were as follows: sex (male/female), 48/27; median age, 61 years (range 5-83; 11 patients (14.7%) were aged under 39 years); and primary sites were lung, 18 (24.7%)/ pancreas, 11 (14.7%)/ hematopoietic organs, 11 (14.7%)/ bones and soft tissues, 8 (10.7%)/ and the others, 27 (36.0%). The main target symptoms for PST were dyspnea (38, 50.7%) and delirium (30, 40.0%). The most commonly used sedative agent was midazolam (72, 96.0%). Continuous deep sedation was intended in 61 patients (81.3%) at the death. Median survival from the start of PST were 2 days (range 0-54). The differences between palliative care team (PCT) intervention group and control group were lower age (58 vs. 62.5, P=0.048) and uniformity of initial midazolam dose (5-12 vs. 9.6-25.2 mg/day). Distinctive feature in this study was large proportion of adolescent and young adult patients with rare cancers. PCT might have different approaches to sedation in comparison to non-PCT medical staffs.