51
|
Bianco A, Pileggi C, Iozzo F, Nobile CGA, Pavia M. Vaccination against human papilloma virus infection in male adolescents: knowledge, attitudes, and acceptability among parents in Italy. Hum Vaccin Immunother 2014; 10:2536-42. [PMID: 25483471 DOI: 10.4161/21645515.2014.969614] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To elicit information about parents' knowledge, attitudes, and acceptability toward HPV infection and vaccination of male adolescents in Italy; to identify subgroups of this population who exhibit poor knowledge about prevention of HPV infection and reveal negative attitudes toward HPV vaccination in relation to their male sons. STUDY DESIGN Data were collected via self-administered anonymous questionnaire from 1021 parents of males aged 10 to 14 y who were recruited from a random sample of public secondary schools in the South of Italy. RESULTS Three-quarters (72.6%) reported that the vaccine is a preventive measure for HPV infection and 55.8% that condom use reduces the risk of HPV infection. A high education level, abundant sources of information about HPV infection received from physicians, and knowledge about HPV infection were factors significantly associated with high level of knowledge about preventive measures for HPV infection. 71% revealed their intentions to vaccinate their sons, and this intention was significantly associated with perceived benefits both for HPV vaccination for girls and for childhood recommended vaccinations as well as a need for additional information about HPV vaccination. 53.7% of the eligible parents reported that their daughters had been vaccinated against HPV. CONCLUSION Results of the study suggest that the risk of acquiring HPV infection and HPV-related diseases is sorely underestimated. Knowledge on the benefits of adolescents' HPV vaccination in cancer prevention in both sexes should be improved to maximize uptake of HPV vaccination.
Collapse
Affiliation(s)
- Aida Bianco
- a Department of Health Sciences ; Medical School ; University of Catanzaro "Magna Græcia;" Catanzaro , Italy
| | | | | | | | | |
Collapse
|
52
|
Soergel P, Makowski L, Schippert C, Staboulidou I, Hille U, Hillemanns P. The cost efficiency of HPV vaccines is significantly underestimated due to omission of conisation-associated prematurity with neonatal mortality and morbidity. Hum Vaccin Immunother 2014; 8:243-51. [DOI: 10.4161/hv.18519] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|
53
|
Kim JJ. Practice-based evidence for primary HPV testing in the United States. J Natl Cancer Inst 2014; 106:dju213. [PMID: 25038468 DOI: 10.1093/jnci/dju213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jane J Kim
- Affiliation of author: Jane J. Kim, Harvard School of Public Health, Department of Health Policy and Management, Center for Health Decision Science, Boston, MA.
| |
Collapse
|
54
|
Wright DR, Austin SB, LeAnn Noh H, Jiang Y, Sonneville KR. The cost-effectiveness of school-based eating disorder screening. Am J Public Health 2014; 104:1774-82. [PMID: 25033131 DOI: 10.2105/ajph.2014.302018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We aimed to assess the value of school-based eating disorder (ED) screening for a hypothetical cohort of US public school students. METHODS We used a decision-analytic microsimulation model to model the effectiveness (life-years with ED and quality-adjusted life-years [QALYs]), total direct costs, and cost-effectiveness (cost per QALY gained) of screening relative to current practice. RESULTS The screening strategy cost $2260 (95% confidence interval [CI] = $1892, $2668) per student and resulted in a per capita gain of 0.25 fewer life-years with ED (95% CI = 0.21, 0.30) and 0.04 QALYs (95% CI = 0.03, 0.05) relative to current practice. The base case cost-effectiveness of the intervention was $9041 per life-year with ED avoided (95% CI = $6617, $12,344) and $56,500 per QALY gained (95% CI = $38,805, $71,250). CONCLUSIONS At willingness-to-pay thresholds of $50,000 and $100,000 per QALY gained, school-based ED screening is 41% and 100% likely to be cost-effective, respectively. The cost-effectiveness of ED screening is comparable to many other accepted pediatric health interventions, including hypertension screening.
Collapse
Affiliation(s)
- Davene R Wright
- Davene R. Wright is with the Department of Pediatrics, University of Washington School of Medicine, and the Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle. S. Bryn Austin is with the Department of Social and Behavioral Sciences, Harvard School of Public Health, and the Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston. Kendrin R. Sonneville is with the Department of Pediatrics, Harvard Medical School, and the Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston. H. LeAnn Noh is with the Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston. Yushan Jiang is with the Department of Global Health and Population, Harvard School of Public Health, Boston
| | | | | | | | | |
Collapse
|
55
|
Burger EA, Kim JJ. The value of improving failures within a cervical cancer screening program: an example from Norway. Int J Cancer 2014; 135:1931-9. [PMID: 24615416 DOI: 10.1002/ijc.28838] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 02/14/2014] [Accepted: 02/20/2014] [Indexed: 11/07/2022]
Abstract
Failures in cervical cancer (CC) screening include nonparticipation, underscreening and loss to follow-up of abnormal results. We estimated the long-term health benefits from and maximum investments in interventions targeted to improving compliance to guidelines while remaining cost-effective. We used a mathematical model empirically calibrated to simulate the natural history of CC in Norway. A baseline scenario reflecting current practice using cytology-based screening was compared to scenarios that target different sources of noncompliance: (i) failure to follow-up women with abnormal results, (ii) screening less frequently than recommended (i.e., underscreening) and (iii) absence of screening. A secondary analysis included human papillomavirus (HPV)-based screening as the primary test. Model outcomes included reductions in lifetime cancer risk and incremental net monetary benefit (INMB) resulting from improvements with compliance. Compared to the status quo, improving all sources of noncompliance leads to important health gains and produced positive INMBs across a range of developed-country willingness-to-pay (WTP) thresholds. For example, a 2% increase in compliance could reduce lifetime cancer risk by 1-3%, depending on the targeted source of noncompliance and primary screening method. Assuming a WTP threshold of $83,000 per year of life saved and cytology-based screening, interventions that increase follow-up of abnormal results yielded the highest INMB per 2% increase in coverage [$19 ($10-21)]. With HPV-based screening, recruiting nonscreeners resulted in the largest INMB [$23 ($18-32)]. Considerable funds could be allocated toward policies that improve compliance with screening under the current cytology-based program or toward adoption of primary HPV-based screening while remaining cost-effective.
Collapse
Affiliation(s)
- Emily A Burger
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | | |
Collapse
|
56
|
Benard VB, Saraiya M, Greek A, Hawkins NA, Roland KB, Manninen D, Ekwueme DU, Miller JW, Unger ER. Overview of the CDC Cervical Cancer (Cx3) Study: an educational intervention of HPV testing for cervical cancer screening. J Womens Health (Larchmt) 2014; 23:197-203. [PMID: 24380501 PMCID: PMC4386595 DOI: 10.1089/jwh.2013.4655] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The recommended screening interval when using the Papanicolaou (Pap) and human papillomavirus (HPV) test (co-testing) is 5 years. However because providers are reluctant to extend the screening interval, we launched a study to identify barriers to appropriate use of the co-test and to implement an educational intervention to promote evidence-based screening practices. This article provides an overview of the study including the multi-component intervention and participant demographics. METHODS The study was conducted in 15 clinics associated with 6 Federally Qualified Health Centers (FQHCs) in Illinois. Each clinic received HPV tests to administer with routine Pap tests among enrolled patients (n=2,246) and was assigned to a study arm: intervention arm (n=7) received a multi-component educational intervention (small media, academic detailing, and website) for providers and printed educational materials for patients, and control arm (n=8) received printed copies of general guidelines. Clinic coordinators (n=15), providers (n=98), and patients (n=984) completed baseline surveys to assess screening practices. RESULTS Providers reported an average age of 41.3 years and were predominately female, non-Hispanic, and white. Patients reported an average age of 45.0 years and nearly two-thirds were Hispanic or black. Of the 2,246 patients, 89% had a normal co-test. Lessons learned from the study included the importance of buy-in at a high level in the organization, a champion provider, and a clinical coordinator devoted to the study. CONCLUSION Materials from this study can be adapted to educate providers and patients on appropriate use of the co-test and encourage extended screening intervals as a safe and effective practice.
Collapse
Affiliation(s)
- Vicki B. Benard
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mona Saraiya
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - April Greek
- Battelle, Health & Analytics, Seattle, Washington
| | | | | | | | | | | | | |
Collapse
|
57
|
Giorgi Rossi P, Baldacchini F, Ronco G. The Possible Effects on Socio-Economic Inequalities of Introducing HPV Testing as Primary Test in Cervical Cancer Screening Programs. Front Oncol 2014; 4:20. [PMID: 24575388 PMCID: PMC3919018 DOI: 10.3389/fonc.2014.00020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 01/24/2014] [Indexed: 11/13/2022] Open
Abstract
Background: Screening with HPV is more effective than Pap test in preventing cervical cancer. HPV as primary test will imply longer intervals and a triage test for HPV positive women. It will also permit the development of self-sampling devices. These innovations may affect population coverage, participation, and compliance to protocols, and likely in a different way for less educated, poorer, and disadvantaged women. Aim: To describe the impact on inequalities, actual or presumed, of the introduction of HPV-based screening. Methods: The putative HPV-based screening algorithm has been analyzed to identify critical points for inequalities. A systematic review of the literature has been conducted searching PubMed on HPV screening coverage, participation, and compliance. Results were summarized in a narrative synthesis. Results: Knowledge about HPV and cervical cancer was lower in women with low socio-economic status and in disadvantaged groups. A correct communication can reduce differences. Longer intervals will make it easier to achieve high-population coverage, but higher cost of the test in private providers could reduce the use of opportunistic screening by disadvantaged women. There are some evidences that inviting for HPV test instead of Pap increases participation, but there are no data on social differences. Self-sampling devices are effective in increasing participation and coverage. Some studies showed that the acceptability of self-sampling is higher in more educated women, but there is also an effect on hard-to-reach women. Communication of HPV positivity may increase anxiety and impact on sexual behaviors, the effect is stronger in low educated and disadvantaged women. Finally, many studies found indirect evidence that unvaccinated women are or will be more probably under-screened. Conclusion: The introduction of HPV test may increase population coverage, but non-compliance to protocols and interaction with opportunistic screening can increase the existing inequalities.
Collapse
Affiliation(s)
- Paolo Giorgi Rossi
- Servizio Interaziendale di Epidemiologia, Azienda Unità Sanitaria Locale di Reggio Emilia , Reggio Emilia , Italy
| | - Flavia Baldacchini
- Servizio Interaziendale di Epidemiologia, Azienda Unità Sanitaria Locale di Reggio Emilia , Reggio Emilia , Italy
| | - Guglielmo Ronco
- Unit of Cancer Epidemiology II, Center for Cancer Epidemiology and Prevention (CPO) , Turin , Italy
| |
Collapse
|
58
|
Goldhaber-Fiebert JD, Brandeau ML. Modeling and calibration for exposure to time-varying, modifiable risk factors: the example of smoking behavior in India. Med Decis Making 2014; 35:196-210. [PMID: 24477078 DOI: 10.1177/0272989x13518272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Risk factors increase the incidence and severity of chronic disease. To examine future trends and develop policies addressing chronic diseases, it is important to capture the relationship between exposure and disease development, which is challenging given limited data. OBJECTIVE To develop parsimonious risk factor models embeddable in chronic disease models, which are useful when longitudinal data are unavailable. DESIGN The model structures encode relevant features of risk factors (e.g., time-varying, modifiable) and can be embedded in chronic disease models. Calibration captures time-varying exposures for the risk factor models using available cross-sectional data. We illustrate feasibility with the policy-relevant example of smoking in India. METHODS The model is calibrated to the prevalence of male smoking in 12 Indian regions estimated from the 2009-2010 Indian Global Adult Tobacco Survey. Nelder-Mead searches (250,000 starting locations) identify distributions of starting, quitting, and restarting rates that minimize the difference between modeled and observed age-specific prevalence. We compare modeled life expectancies to estimates in the absence of time-varying risk exposures and consider gains from hypothetical smoking cessation programs delivered for 1 to 30 years. RESULTS Calibration achieves concordance between modeled and observed outcomes. Probabilities of starting to smoke rise and fall with age, while quitting and restarting probabilities fall with age. Accounting for time-varying smoking exposures is important, as not doing so produces smaller estimates of life expectancy losses. Estimated impacts of smoking cessation programs delivered for different periods depend on the fact that people who have been induced to abstain from smoking longer are less likely to restart. CONCLUSIONS The approach described is feasible for important risk factors for numerous chronic diseases. Incorporating exposure-change rates can improve modeled estimates of chronic disease outcomes and of the long-term effects of interventions targeting risk factors.
Collapse
Affiliation(s)
- Jeremy D Goldhaber-Fiebert
- Stanford Health Policy, Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA (JDG-F)
| | - Margaret L Brandeau
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA (MLB)
| |
Collapse
|
59
|
Harper DM, Groner JA. Positive high-risk HPV test with negative cytology--a conundrum and blessing of our latest technology. Cancer Epidemiol Biomarkers Prev 2014; 23:10-1. [PMID: 24420983 DOI: 10.1158/1055-9965.epi-13-0708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Diane M Harper
- Authors' Affiliations: Departments of Obstetrics and Gynecology, Community and Family Medicine, Biomedical and Health Informatics, and Community and Family Medicine, University of Missouri Kansas City, Leawood, Kansas
| | | |
Collapse
|
60
|
Richardson LA, Tota J, Franco EL. Optimizing technology for cervical cancer screening in high-resource settings. ACTA ACUST UNITED AC 2014; 6:343-353. [PMID: 26617667 DOI: 10.1586/eog.11.13] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although historically successful in reducing the burden of cervical cancer, Papanicolaou (Pap) testing faces numerous limitations. A growing body of evidence suggests that modern screening practice will benefit from primary screening for high-risk human papillomavirus (HPV) infection, the causative agent of cervical cancer. Molecular tests detecting the presence of HPV nucleic acids consistently demonstrate high sensitivity relative to Pap testing, and provide reliable, dichotomous results. Pap cytology is ideally suited to triage HPV-positive cases owing to its high test specificity, and the accuracy of cytological readings will be maximized in high-prevalence conditions. This algorithm of primary HPV testing with Pap triage has been shown to maintain the high sensitivity of HPV testing without compromising Pap cytology's strong ability to rule out falsely positive diagnoses. Given the anticipated decline of high-risk HPV-16 and -18 infections in the emergent post-HPV vaccination era, highly sensitive primary HPV testing is especially warranted. Novel screening technologies that identify HPV viral gene expression continue to emerge and seek to complement current HPV testing by identifying those women who may be at risk of progressive disease. How to best incorporate these new technologies into clinical practice presents our next great challenge. Implementation of novel algorithms for cervical screening is not a trivial task. Avoidance of exceedingly complex screening algorithms is an important priority.
Collapse
Affiliation(s)
- Lyndsay A Richardson
- Division of Cancer Epidemiology, McGill University, 546 Pine Avenue West, Montreal, QC, H2W 1S6, Canada
| | - Joseph Tota
- Division of Cancer Epidemiology, McGill University, 546 Pine Avenue West, Montreal, QC, H2W 1S6, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, 546 Pine Avenue West, Montreal, QC, H2W 1S6, Canada
| |
Collapse
|
61
|
Dasbach EJ, Largeron N, Elbasha EH. Assessment of the cost–effectiveness of a quadrivalent HPV vaccine in Norway using a dynamic transmission model. Expert Rev Pharmacoecon Outcomes Res 2014; 8:491-500. [DOI: 10.1586/14737167.8.5.491] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
62
|
de Kok IMCM, van Rosmalen J, Rozemeijer K, Penning C, van Ballegooijen M. How many cervical cancer cases can potentially be prevented using a more sensitive screening test at young age? Int J Cancer 2013; 134:460-6. [PMID: 23824905 DOI: 10.1002/ijc.28366] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 06/10/2013] [Accepted: 06/14/2013] [Indexed: 11/11/2022]
Abstract
The human papilloma virus (HPV) DNA test has higher sensitivity than cytology for cervical cancer screening. Therefore, cervical cancer cases that are missed by cytology could potentially be identified if we use primary HPV testing. Studies showed that HPV screening is the preferred primary test at age 35 and over. Given the high prevalence of harmless HPV infections, the use of HPV testing at younger age is less obvious. The number of cancers in young age is often mentioned to indicate the possible benefits of a more sensitive test. We actually estimated the proportion of those cases that is potentially preventable in The Netherlands by the use of a more sensitive screen-test at the first screening age 30, given that the more sensitive test is used at age 35 and over. We analysed the screening history of women diagnosed with cervical cancer in the period 2004 to March 2009, using data from the Dutch National Pathology Registry. Only 15-30% (two to four cases per 100,000 women) of the cases was preceded by negative cytology under age 35 and therefore could have been prevented by a more sensitive test at age 30. The lower the screening coverage and the shorter the screening interval in those screened at young age, the smaller the gain of a more sensitive test. So, as long as the current screening pattern is not changed, the majority of the cervical cancer cases at young age would still occur even when applying a more sensitive test at the younger ages.
Collapse
Affiliation(s)
- Inge M C M de Kok
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | | | | | | |
Collapse
|
63
|
Jackson CH, Jit M, Sharples LD, De Angelis D. Calibration of complex models through Bayesian evidence synthesis: a demonstration and tutorial. Med Decis Making 2013; 35:148-61. [PMID: 23886677 DOI: 10.1177/0272989x13493143] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Decision-analytic models must often be informed using data that are only indirectly related to the main model parameters. The authors outline how to implement a Bayesian synthesis of diverse sources of evidence to calibrate the parameters of a complex model. A graphical model is built to represent how observed data are generated from statistical models with unknown parameters and how those parameters are related to quantities of interest for decision making. This forms the basis of an algorithm to estimate a posterior probability distribution, which represents the updated state of evidence for all unknowns given all data and prior beliefs. This process calibrates the quantities of interest against data and, at the same time, propagates all parameter uncertainties to the results used for decision making. To illustrate these methods, the authors demonstrate how a previously developed Markov model for the progression of human papillomavirus (HPV-16) infection was rebuilt in a Bayesian framework. Transition probabilities between states of disease severity are inferred indirectly from cross-sectional observations of prevalence of HPV-16 and HPV-16-related disease by age, cervical cancer incidence, and other published information. Previously, a discrete collection of plausible scenarios was identified but with no further indication of which of these are more plausible. Instead, the authors derive a Bayesian posterior distribution, in which scenarios are implicitly weighted according to how well they are supported by the data. In particular, we emphasize the appropriate choice of prior distributions and checking and comparison of fitted models.
Collapse
Affiliation(s)
| | - Mark Jit
- Health Protection Agency, London, UK (MJ)
| | | | | |
Collapse
|
64
|
Kacker S, Frick KD, Quinn TC, Gray RH, Tobian AAR. Financial implications of male circumcision scale-up for the prevention of HIV and other sexually transmitted infections in a sub-Saharan African community. Sex Transm Dis 2013; 40:559-68. [PMID: 23965771 PMCID: PMC3752094 DOI: 10.1097/olq.0b013e3182945e56] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The financial implications of male circumcision (MC) scale-up in sub-Saharan Africa associated with reduced HIV have been evaluated. However, no analysis has incorporated the expected reduction of a comprehensive set of other sexually transmitted infections including human papillomavirus, herpes simplex virus type 2, genital ulcer disease, bacterial vaginosis, and trichomoniasis. METHODS A Markov model tracked a dynamic population undergoing potential MC scale-up, as individuals experienced MC procedures, procedure-related adverse events, and MC-reduced sexually transmitted infections and accrued any associated costs. Rakai, Uganda, was used as a prototypical rural sub-Saharan African community. Monte Carlo microsimulations evaluated outcomes under 4 alternative scale-up strategies to reach 80% MC coverage among men aged 15 to 49 years, in addition to a baseline strategy defined by current MC rates in central Uganda. Financial outcomes included direct medical expenses only and were evaluated over 5 and 25 years. Costs were discounted to the beginning of each period, coinciding with the start of MC scale-up, and expressed in US $2012. RESULTS Cost savings from infections averted by MC vary from US $197,531 after 5 years of a scale-up program focusing on adolescent/adult procedures to more than US $13 million after 25 years, under a strategy incorporating increased infant MCs. Over a 5-year period, reduction in HIV contributes to 50% of cost savings, and for 25 years, this contribution rises to nearly 90%. CONCLUSIONS Sexually transmitted infections other than HIV contribute to cost savings associated with MC scale-up. Previous analyses, focusing exclusively on the financial impact through averted HIV, may have underestimated true cost savings by 10% to 50%.
Collapse
Affiliation(s)
- Seema Kacker
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | | | | | | | | |
Collapse
|
65
|
Castle PE, Cremer M. Human Papillomavirus Testing in Cervical Cancer Screening. Obstet Gynecol Clin North Am 2013; 40:377-90. [DOI: 10.1016/j.ogc.2013.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
66
|
Horn J, Damm O, Kretzschmar MEE, Deleré Y, Wichmann O, Kaufmann AM, Garbe E, Krämer A, Greiner W, Mikolajczyk RT. Estimating the long-term effects of HPV vaccination in Germany. Vaccine 2013; 31:2372-80. [PMID: 23518405 DOI: 10.1016/j.vaccine.2013.03.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 02/22/2013] [Accepted: 03/04/2013] [Indexed: 12/15/2022]
Abstract
In Germany, vaccination against the most oncogenic HPV types 16/18 is recommended by the Standing Committee on Vaccination (STIKO) for 12-17 year old girls since March 2007. We developed a dynamic mathematical model for the natural history and transmission of HPV infections to estimate the impact of vaccination on incidence and mortality of cervical cancer and its pre-stages, and on anogenital warts. We focused on an extensive model calibration to epidemiologic data for all stages of the natural history model as well as on a detailed implementation of cervical cancer screening modalities in Germany. Our model predicts first a substantial reduction of cervical cancer incidence and mortality over the next 30 years, which is mainly attributable to an increase in screening participation in the 1990s and not to HPV vaccination, followed by a further reduction attributable to vaccination. Over the next 100 years, HPV vaccination will prevent approximately 37% of cervical cancer cases even if vaccination coverage is only 50% (as currently observed in Germany). Consideration of cross-protection results in a further reduction of approximately 7% of all cervical cancer cases for the bivalent and about 5% for the quadrivalent vaccine in our model. Vaccination of boys was only reasonable if moderate to high vaccination coverage in girls was not achieved. Strategies should be implemented in Germany to increase HPV vaccination coverage among girls thereby making better use of the demonstrated benefits of the vaccine.
Collapse
Affiliation(s)
- J Horn
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
67
|
|
68
|
Goldhaber-Fiebert JD, Rubinfeld RE, Bhattacharya J, Robinson TN, Wise PH. The utility of childhood and adolescent obesity assessment in relation to adult health. Med Decis Making 2013; 33:163-75. [PMID: 22647830 PMCID: PMC3968272 DOI: 10.1177/0272989x12447240] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND High childhood obesity prevalence has raised concerns about future adult health, generating calls for obesity screening of young children. OBJECTIVE To estimate how well childhood obesity predicts adult obesity and to forecast obesity-related health of future US adults. DESIGN Longitudinal statistical analyses; microsimulations combining multiple data sets. DATA SOURCES National Longitudinal Survey of Youth, Population Study of Income Dynamics, and National Health and Nutrition Evaluation Surveys. METHODS The authors estimated test characteristics and predictive values of childhood body mass index to identify 2-, 5-, 10-, and 15 year-olds who will become obese adults. The authors constructed models relating childhood body mass index to obesity-related diseases through middle age stratified by sex and race. RESULTS Twelve percent of 18-year-olds were obese. While screening at age 5 would miss 50% of those who become obese adults, screening at age 15 would miss 9%. The predictive value of obesity screening below age 10 was low even when maternal obesity was included as a predictor. Obesity at age 5 was a substantially worse predictor of health in middle age than was obesity at age 15. For example, the relative risk of developing diabetes as adults for obese white male 15-year-olds was 4.5 versus otherwise similar nonobese 15-year-olds. For obese 5-year-olds, the relative risk was 1.6. LIMITATION Main results do not include Hispanics due to sample size. Past relationships between childhood and adult obesity and health may change in the future. CONCLUSION Early childhood obesity assessment adds limited information to later childhood assessment. Targeted later childhood approaches or universal strategies to prevent unhealthy weight gain should be considered.
Collapse
Affiliation(s)
| | - Rachel E. Rubinfeld
- Stanford Health Policy, Department of Medicine, School of Medicine, Stanford University, Stanford, CA
| | - Jay Bhattacharya
- Stanford Health Policy, Department of Medicine, School of Medicine, Stanford University, Stanford, CA
| | - Thomas N. Robinson
- Department of Pediatrics, School of Medicine, Stanford University, Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, and Center for Policy, Outcomes and Prevention, Lucile Packard Children’s Hospital, Stanford, CA
| | - Paul H. Wise
- Department of Pediatrics, School of Medicine, Stanford University, Center for Policy, Outcomes and Prevention, Lucile Packard Children’s Hospital, Stanford, CA
| |
Collapse
|
69
|
Canfell K, Chesson H, Kulasingam SL, Berkhof J, Diaz M, Kim JJ. Modeling preventative strategies against human papillomavirus-related disease in developed countries. Vaccine 2012; 30 Suppl 5:F157-67. [PMID: 23199959 PMCID: PMC3783354 DOI: 10.1016/j.vaccine.2012.06.091] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 06/11/2012] [Accepted: 06/13/2012] [Indexed: 02/08/2023]
Abstract
Over the last 5 years, prophylactic vaccination against human papillomavirus (HPV) in pre-adolescent females has been introduced in most developed countries, supported by modeled evaluations that have almost universally found vaccination of pre-adolescent females to be cost-effective. Studies to date suggest that vaccination of pre-adolescent males may also be cost-effective at a cost per vaccinated individual of ~US$400-500 if vaccination coverage in females cannot be increased above ~50%; but if it is possible, increasing coverage in females appears to be a better return on investment. Comparative evaluation of the quadrivalent (HPV16,18,6,11) and bivalent (HPV16,18) vaccines centers around the potential trade-off between protection against anogenital warts and vaccine-specific levels of cross-protection against infections not targeted by the vaccines. Future evaluations will also need to consider the cost-effectiveness of a next generation nonavalent vaccine designed to protect against ~90% of cervical cancers. The timing of the effect of vaccination on cervical screening programs will be country-specific and will depend on vaccination catch-up age range and coverage and the age at which screening starts. Initial evaluations suggest that if screening remains unchanged, it will be less cost-effective in vaccinated compared to unvaccinated women but, in the context of current vaccines, will remain an important prevention method. Comprehensive evaluation of new approaches to screening will need to consider the population-level effects of vaccination over time. New screening strategies of particular interest include delaying the start age of screening, increasing the screening interval and switching to primary HPV screening. Future evaluations of screening will also need to focus on the effects of disparities in screening and vaccination uptake, the potential effects of vaccination on screening participation, and the effects of imperfect compliance with screening recommendations. This article forms part of a special supplement entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.
Collapse
Affiliation(s)
- Karen Canfell
- Cancer Epidemiology Research Unit, Cancer Council NSW, Sydney, Australia.
| | | | | | | | | | | |
Collapse
|
70
|
Goldhaber-Fiebert JD, Bailey SL, Hurlburt MS, Zhang J, Snowden LR, Wulczyn F, Landsverk J, Horwitz SM. Evaluating child welfare policies with decision-analytic simulation models. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2012; 39:466-77. [PMID: 21861204 PMCID: PMC3589566 DOI: 10.1007/s10488-011-0370-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The objective was to demonstrate decision-analytic modeling in support of Child Welfare policymakers considering implementing evidence-based interventions. Outcomes included permanency (e.g., adoptions) and stability (e.g., foster placement changes). Analyses of a randomized trial of KEEP-a foster parenting intervention-and NSCAW-1 estimated placement change rates and KEEP's effects. A microsimulation model generalized these findings to other Child Welfare systems. The model projected that KEEP could increase permanency and stability, identifying strategies targeting higher-risk children and geographical regions that achieve benefits efficiently. Decision-analytic models enable planners to gauge the value of potential implementations.
Collapse
|
71
|
O'Mahony JF, van Rosmalen J, Zauber AG, van Ballegooijen M. Multicohort models in cost-effectiveness analysis: why aggregating estimates over multiple cohorts can hide useful information. Med Decis Making 2012; 33:407-14. [PMID: 22927697 DOI: 10.1177/0272989x12453503] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Models used in cost-effectiveness analysis (CEA) of screening programs may include 1 or many birth cohorts of patients. As many screening programs involve multiple screens over many years for each birth cohort, the actual implementation of screening often involves multiple concurrent recipient cohorts. Consequently, some advocate modeling all recipient cohorts rather than 1 birth cohort, arguing it more accurately represents actual implementation. However, reporting the cost-effectiveness estimates for multiple cohorts on aggregate rather than per cohort will fail to account for any heterogeneity in cost-effectiveness between cohorts. Such heterogeneity may be policy relevant where there is considerable variation in cost-effectiveness between cohorts, as in the case of cancer screening programs with multiple concurrent recipient birth cohorts, each at different stages of screening at any one point in time. OBJECTIVE The purpose of this study is to illustrate the potential disadvantages of aggregating cost-effectiveness estimates over multiple cohorts, without first considering the disaggregate estimates. Analysis. We estimate the cost-effectiveness of 2 alternative cervical screening tests in a multicohort model and compare the aggregated and per-cohort estimates. We find instances in which the policy choices suggested by the aggregate and per-cohort results differ. We use this example to illustrate a series of potential disadvantages of aggregating CEA estimates over cohorts. CONCLUSIONS Recent recommendations that CEAs should consider the cost-effectiveness of more than just a single cohort appear justified, but the aggregation of estimates across multiple cohorts into a single estimate does not.
Collapse
Affiliation(s)
- James F O'Mahony
- Department of Public Health, Erasmus MC, Erasmus University, Rotterdam, the Netherlands (JFO’M, JvR, MvB),Department of Health Policy and Management, Trinity College Dublin, Dublin, Ireland (JFO’M)
| | - Joost van Rosmalen
- Department of Public Health, Erasmus MC, Erasmus University, Rotterdam, the Netherlands (JFO’M, JvR, MvB)
| | - Ann G Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York (AGZ)
| | - Marjolein van Ballegooijen
- Department of Public Health, Erasmus MC, Erasmus University, Rotterdam, the Netherlands (JFO’M, JvR, MvB)
| |
Collapse
|
72
|
Yin G, Li J, Zhu T, Zhao X. The detection of hTERC amplification using fluorescence in situ hybridization in the diagnosis and prognosis of cervical intraepithelial neoplasia: a case control study. World J Surg Oncol 2012; 10:168. [PMID: 22909227 PMCID: PMC3485165 DOI: 10.1186/1477-7819-10-168] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 07/23/2012] [Indexed: 11/10/2022] Open
Abstract
Background Currently the routine non-invasive screening methods for cervical intraepithelial neoplasia (CIN) and cervical cancer are Thinprep cytology test (TCT) and human papillomavirus testing. However, both methods are limited by the high false positive and false negative rates and lack of association with patients’ prognosis, especially for the early detection of pro-malignant CIN. The aim of the study was to investigate the role of genomic amplification of human telomerase gene (hTERC) in the diagnosis and prognosis of CIN. Methods The study group consisted of specimens of exfoliated cervical cells from 151 patients, including 27 with CIN I, 54 with CIN II/III, 17 with carcinoma in situ, and 28 with invasive squamous carcinoma, as well as 25 patients who were at 2-year follow-up after either Loop Electrosurgical Excision treatment (n = 11) or radical surgery (n = 14). hTERC amplification was detected by dual-color interphase fluorescence in situ hybridization (FISH), and the results were compared with TCT and histologic examination. The final diagnosis was determined by the pathological examination. The control group consisted of specimens of exfoliated cervical cells from 40 normal women. Results The percentage of cervical exfoliated cells with positive hTERC amplification and incidence rates of hTERC amplification were 9.2% ± 4.6% and 44.4% (12/27) respectively in patients with CIN I; 16.0% ± 14.4% and 85.1% (46/54) in patients with CIN II/III; 19.7% ± 13.3% and 88.3% (15 /17) in patients with carcinoma in situ; 47.0% ± 25.2% and 100% (28/28)in patients with invasive squamous carcinoma. There was statistically significant difference between the control and study group (P <0.01), and between the patients with various diseases within the study group (P <0.05). Conclusion The detection of genomic amplification of hTERC using FISH is a non-invasive and effective approach for CIN.
Collapse
Affiliation(s)
- Geping Yin
- Department of Obstetrics & Gynecology, Jinan Military General Hospital, 25 Shifan Road, Jinan 250031, China.
| | | | | | | |
Collapse
|
73
|
Chesson HW, Ekwueme DU, Saraiya M, Watson M, Lowy DR, Markowitz LE. Estimates of the annual direct medical costs of the prevention and treatment of disease associated with human papillomavirus in the United States. Vaccine 2012; 30:6016-9. [PMID: 22867718 DOI: 10.1016/j.vaccine.2012.07.056] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 07/18/2012] [Accepted: 07/24/2012] [Indexed: 10/28/2022]
Abstract
Estimates of the direct medical costs attributable to human papillomavirus (HPV) can help to quantify the economic burden of HPV and to illustrate the potential benefits of HPV vaccination. The purpose of this report was to update the estimated annual direct medical costs of the prevention and treatment of HPV-associated disease in the United States, for all HPV types. We included the costs of cervical cancer screening and follow-up and the treatment costs of the following HPV-associated health outcomes: cervical cancer, other anogenital cancers (anal, vaginal, vulvar and penile), oropharyngeal cancer, genital warts, and recurrent respiratory papillomatosis (RRP). We obtained updated incidence and cost estimates from the literature. The overall annual direct medical cost burden of preventing and treating HPV-associated disease was estimated to be $8.0 billion (2010 U.S. dollars). Of this total cost, about $6.6 billion (82.3%) was for routine cervical cancer screening and follow-up, $1.0 billion (12.0%) was for cancer (including $0.4 billion for cervical cancer and $0.3 billion for oropharyngeal cancer), $0.3 billion (3.6%) was for genital warts, and $0.2 billion (2.1%) was for RRP.
Collapse
Affiliation(s)
- Harrell W Chesson
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | | | | | | | | |
Collapse
|
74
|
Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain JM, Garcia FAR, Moriarty AT, Waxman AG, Wilbur DC, Wentzensen N, Downs LS, Spitzer M, Moscicki AB, Franco EL, Stoler MH, Schiffman M, Castle PE, Myers ER, Chelmow D, Herzig A, Kim JJ, Kinney W, Herschel WL, Waldman J. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. J Low Genit Tract Dis 2012; 16:175-204. [PMID: 22418039 PMCID: PMC3915715 DOI: 10.1097/lgt.0b013e31824ca9d5] [Citation(s) in RCA: 237] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
An update to the American Cancer Society (ACS) guideline regarding screening for the early detection of cervical precancerous lesions and cancer is presented. The guidelines are based on a systematic evidence review, contributions from six working groups, and a recent symposium co-sponsored by the ACS, American Society for Colposcopy and Cervical Pathology (ASCCP), and American Society for Clinical Pathology (ASCP), which was attended by 25 organizations. The new screening recommendations address age-appropriate screening strategies, including the use of cytology and high-risk human papillomavirus (HPV) testing, follow-up (e.g., management of screen positives and screening interval for screen negatives) of women after screening, age at which to exit screening, future considerations regarding HPV testing alone as a primary screening approach, and screening strategies for women vaccinated against HPV16/18 infections.
Collapse
Affiliation(s)
- Debbie Saslow
- Breast and Gynecologic Cancer, Cancer Control Science Department, American Cancer Society, Atlanta, GA 30303, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
75
|
Wheeler CM, Hunt WC, Cuzick J, Langsfeld E, Pearse A, Montoya GD, Robertson M, Shearman CA, Castle PE. A population-based study of human papillomavirus genotype prevalence in the United States: baseline measures prior to mass human papillomavirus vaccination. Int J Cancer 2012; 132:198-207. [PMID: 22532127 DOI: 10.1002/ijc.27608] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 04/13/2012] [Indexed: 11/08/2022]
Abstract
Currently, two prophylactic human papillomavirus (HPV) vaccines targeting HPV 16 and 18 have been shown to be highly efficacious for preventing precursor lesions although the effectiveness of these vaccines in real-world clinical settings must still be determined. Toward this end, an ongoing statewide surveillance program was established in New Mexico to assess all aspects of cervical cancer preventive care. Given that the reduction in cervical cancer incidence is expected to take several decades to manifest, a systematic population-based measurement of HPV type-specific prevalence employing an age- and cytology-stratified sample of 47,617 women attending for cervical screening was conducted prior to widespread HPV vaccination. A well-validated polymerase chain reaction (PCR) method for 37 HPV genotypes was used to test liquid-based cytology specimens. The prevalence for any of the 37 HPV types was 27.3% overall with a maximum of 52% at age of 20 years followed by a rapid decline at older ages. The HPV 16 prevalences in women aged ≤ 20 years, 21-29 years or ≥ 30 years were 9.6, 6.5 and 1.8%, respectively. The combined prevalences of HPV 16 and 18 in these age groups were 12.0, 8.3 and 2.4%, respectively. HPV 16 and/or HPV 18 were detected in 54.5% of high-grade squamous intraepithelial (cytologic) lesions (HSIL) and in 25.0% of those with low-grade SIL (LSIL). These baseline data enable estimates of maximum HPV vaccine impact across time and provide critical reference measurements important to assessing clinical benefits and potential harms of HPV vaccination including increases in nonvaccine HPV types (i.e., type replacement).
Collapse
Affiliation(s)
- Cosette M Wheeler
- Department of Pathology and Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, House of Prevention Epidemiology, Albuquerque, NM87131 , USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
76
|
Origoni M, Cristoforoni P, Costa S, Mariani L, Scirpa P, Lorincz A, Sideri M. HPV-DNA testing for cervical cancer precursors: from evidence to clinical practice. Ecancermedicalscience 2012; 6:258. [PMID: 22778786 PMCID: PMC3388143 DOI: 10.3332/ecancer.2012.258] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Indexed: 11/17/2022] Open
Abstract
The large amount of literature published over the last two decades on human papillomavirus (HPV)-DNA testing has definitely demonstrated the association between high-risk viral genotypes (hrHPV) and cervical cancer. Moreover, hrHPV-DNA testing has shown excellent performance in several clinical applications, from screening settings to the follow-up of treated patients, compared to conventional cytology or colposcopy options. On the other hand, when a huge number of reports are published on the same subject in a relatively short period of time, with many variations in settings, study designs and applications, the result is often confusion and decreased comprehension by readers. In daily office practice, several different situations (in symptomatic or asymptomatic women) can be positively managed by the correct use of hrHPV-DNA testing. Validated hrHPV-DNA testing and, specifically, the HC2® assay, due to its excellent sensitivity and negative predictive value together with optimal reproducibility, currently represent a powerful tool in the clinician’s hands to optimally manage several situations related to HPV infection and the potential development of cervical cancer.
Collapse
|
77
|
Seto K, Marra F, Raymakers A, Marra CA. The cost effectiveness of human papillomavirus vaccines: a systematic review. Drugs 2012; 72:715-43. [PMID: 22413761 DOI: 10.2165/11599470-000000000-00000] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Human papillomavirus (HPV) is one of the world's most common sexually transmitted infections, and has been associated with a number of cervical and non-cervical diseases, including cancer. HPV vaccines have been licensed for use in females for some time, but the quadrivalent vaccine has only recently become licensed for use in males. Many countries have adopted a vaccination programme for adolescent females based on results of cost-effectiveness analyses. However, given the new indications for use of the vaccine in males, decision makers require information on the cost effectiveness of vaccinating males in order to make policy decisions on whether or not to fund such programmes. OBJECTIVE Our objective was to conduct a qualitative systematic review to update a previously conducted review of HPV vaccine studies. METHODS Articles were obtained from an extensive literature search to determine the cost effectiveness of implementing an HPV vaccination programme with routine cervical cancer screening. A total of 29 studies were included in this review. Seventeen of the included articles looked only at cervical disease outcomes, and 12 studies also included non-cervical disease outcomes. Four studies explored the economic impact of vaccinating both boys and girls. One study focused on a population of men who have sex with men (MSM). RESULTS While different model structures, input parameters and baseline assumptions were used, the consistent message in studies that focused on female-only vaccination programmes was that routine vaccination of females is cost effective compared with cervical cancer screening alone. DISCUSSION Based on the currently available literature, it appears that the addition of boys to a vaccination programme generally exceeds traditional cost-effectiveness thresholds. The MSM population represents a potential additional target for routine HPV vaccination; however, more cost-effectiveness studies are required before making such a policy change.
Collapse
Affiliation(s)
- Katherine Seto
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | | | | | | |
Collapse
|
78
|
Davies P. Public awareness and cervical cancer screening. Cytopathology 2012; 23:143-5. [DOI: 10.1111/j.1365-2303.2012.00984.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
79
|
Economic modelling assessment of the HPV quadrivalent vaccine in Brazil: a dynamic individual-based approach. Vaccine 2012; 30:4866-71. [PMID: 22652405 DOI: 10.1016/j.vaccine.2012.04.087] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 04/14/2012] [Accepted: 04/24/2012] [Indexed: 01/04/2023]
Abstract
We examined the cost-effectiveness of the quadrivalent HPV vaccine for the pre-adolescent female population of Brazil. Using demographic, epidemiological and cancer data, we developed a dynamic individual-based model representing the natural history of HPV/cervical cancer as well as the impact of screening and vaccination programmes. Assuming the current screening strategies, we calculated the incremental cost-effectiveness ratio (ICER) for cohorts with and without vaccination taking into account different combinations of vaccination coverage (50%, 70%, 90%) and cost per vaccinated woman (US$25, US$55, US$125, US$556). The results varied from cost-saving (coverage 50% or 70% and cost per vaccinated woman US$25) to 5950 US$/QALY (coverage 90% and cost per vaccinated 556 US$). In a scenario in which a booster shot was needed after 10 years in order to secure lifelong protection, the ICER resulted in 13,576 US$/QALY. Considering the very cost-effective and cost-effective thresholds based on Brazil's GDP per capita, apart from the booster scenario which would be deemed cost-effective, all the other scenarios would be deemed very cost-effective. Both the cost per dose of vaccine and discount rate (5%) had an important impact on the results. Vaccination in addition to the current screening programme is likely to save years of life and, depending on the cost of vaccination, may even save resources. Price negotiations between governments and manufacturers will be paramount in determining that the vaccine not only represents good value for money, but is also affordable in middle-income countries like Brazil.
Collapse
|
80
|
Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, Garcia FAR, Moriarty AT, Waxman AG, Wilbur DC, Wentzensen N, Downs LS, Spitzer M, Moscicki AB, Franco EL, Stoler MH, Schiffman M, Castle PE, Myers ER. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin 2012; 62:147-72. [PMID: 22422631 PMCID: PMC3801360 DOI: 10.3322/caac.21139] [Citation(s) in RCA: 787] [Impact Index Per Article: 65.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
An update to the American Cancer Society (ACS) guideline regarding screening for the early detection of cervical precancerous lesions and cancer is presented. The guidelines are based on a systematic evidence review, contributions from 6 working groups, and a recent symposium cosponsored by the ACS, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology, which was attended by 25 organizations. The new screening recommendations address age-appropriate screening strategies, including the use of cytology and high-risk human papillomavirus (HPV) testing, follow-up (eg, the management of screen positives and screening intervals for screen negatives) of women after screening, the age at which to exit screening, future considerations regarding HPV testing alone as a primary screening approach, and screening strategies for women vaccinated against HPV16 and HPV18 infections.
Collapse
Affiliation(s)
- Debbie Saslow
- Cancer Control Science Department, American Cancer Society, Atlanta, GA 30303, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
81
|
van Rosmalen J, de Kok IMCM, van Ballegooijen M. Cost-effectiveness of cervical cancer screening: cytology versus human papillomavirus DNA testing. BJOG 2012; 119:699-709. [PMID: 22251259 PMCID: PMC3489039 DOI: 10.1111/j.1471-0528.2011.03228.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2011] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To determine the most cost-effective screening programme for cervical cancer. DESIGN Cost-effectiveness analysis from a societal perspective. SETTING The Netherlands. POPULATION Dutch women who have not been invited for human papillomavirus (HPV) vaccination. METHODS We calibrated the microsimulation screening analysis (MISCAN) model to Dutch epidemiological data. We used this model to consider nine screening strategies that use: (i) cytological testing with cytology triage for borderline/mildly abnormal smears; (ii) HPV testing with cytology triage for HPV-positive smears; or (iii) cytological testing with HPV triage for borderline/mildly abnormal smears. For each strategy, we varied the number of screening rounds, the time interval, the age of the first screening, and the type of cytological testing (conventional or liquid-based cytology). MAIN OUTCOME MEASURES Quality-adjusted life years (QALYs) gained and costs from a societal perspective. RESULTS Under the base-case assumptions, primary HPV testing with cytology triage is the most cost-effective strategy. Using cost-effectiveness thresholds of € 20,000 and € 50,000 per QALY gained yields optimal screening programmes with three and seven screening rounds, respectively. The results are sensitive to several uncertain model inputs, most importantly the costs of the HPV test. For women aged 32 years or younger, primary cytology screening is more cost-effective than primary HPV testing. CONCLUSIONS Increasing the interval between screening rounds and changing the primary test from cytology to HPV testing can improve the effectiveness and decrease the costs of cervical cancer screening in the Netherlands.
Collapse
Affiliation(s)
- J van Rosmalen
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | | | | |
Collapse
|
82
|
Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, Garcia FAR, Moriarty AT, Waxman AG, Wilbur DC, Wentzensen N, Downs LS, Spitzer M, Moscicki AB, Franco EL, Stoler MH, Schiffman M, Castle PE, Myers ER. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Am J Clin Pathol 2012; 137:516-42. [PMID: 22431528 DOI: 10.1309/ajcptgd94evrsjcg] [Citation(s) in RCA: 532] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
An update to the American Cancer Society (ACS) guideline regarding screening for the early detection of cervical precancerous lesions and cancer is presented. The guidelines are based on a systematic evidence review, contributions from 6 working groups, and a recent symposium cosponsored by the ACS, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology, which was attended by 25 organizations. The new screening recommendations address age-appropriate screening strategies, including the use of cytology and high-risk human papillomavirus (HPV) testing, follow-up (eg, the management of screen positives and screening intervals for screen negatives) of women after screening, the age at which to exit screening, future considerations regarding HPV testing alone as a primary screening approach, and screening strategies for women vaccinated against HPV16 and HPV18 infections.
Collapse
|
83
|
Burger EA, Ortendahl JD, Sy S, Kristiansen IS, Kim JJ. Cost-effectiveness of cervical cancer screening with primary human papillomavirus testing in Norway. Br J Cancer 2012; 106:1571-8. [PMID: 22441643 PMCID: PMC3341862 DOI: 10.1038/bjc.2012.94] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: New screening technologies and vaccination against human papillomavirus (HPV), the necessary cause of cervical cancer, may impact optimal approaches to prevent cervical cancer. We evaluated the cost-effectiveness of alternative screening strategies to inform cervical cancer prevention guidelines in Norway. Methods: We leveraged the primary epidemiologic and economic data from Norway to contextualise a simulation model of HPV-induced cervical cancer. The current cytology-only screening was compared with strategies involving cytology at younger ages and primary HPV-based screening at older ages (31/34+ years), an option being actively deliberated by the Norwegian government. We varied the switch-age, screening interval, and triage strategies for women with HPV-positive results. Uncertainty was evaluated in sensitivity analysis. Results: Current cytology-only screening was less effective and more costly than strategies that involve switching to primary HPV testing in older ages. For unvaccinated women, switching at age 34 years to primary HPV testing every 4 years was optimal given the Norwegian cost-effectiveness threshold ($83 000 per year of life saved). For vaccinated women, a 6-year screening interval was cost-effective. When we considered a wider range of strategies, we found that an earlier switch to HPV testing (at age 31 years) may be preferred. Conclusions: Strategies involving a switch to HPV testing for primary screening in older women is expected to be cost-effective compared with current recommendations in Norway.
Collapse
Affiliation(s)
- E A Burger
- Department of Health Management and Health Economics, University of Oslo, Norway
| | | | | | | | | |
Collapse
|
84
|
de Kok IMCM, van Rosmalen J, Dillner J, Arbyn M, Sasieni P, Iftner T, van Ballegooijen M. Primary screening for human papillomavirus compared with cytology screening for cervical cancer in European settings: cost effectiveness analysis based on a Dutch microsimulation model. BMJ 2012; 344:e670. [PMID: 22391612 PMCID: PMC3293782 DOI: 10.1136/bmj.e670] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate, using a Dutch model, whether and under what variables framed for other European countries screening for human papillomavirus (HPV) is preferred over cytology screening for cervical cancer, and to calculate the preferred number of examinations over a woman's lifetime. DESIGN Cost effectiveness analysis based on a Dutch simulation model. Base case analyses investigated the cost effectiveness of more than 1500 different screening policies using the microsimulation model. Subsequently, the policies were compared for five different scenarios that represent different possible scenarios (risk of cervical cancer, previous screening, quality associated test characteristics, costs of testing, and prevalence of HPV). SETTING Various European countries. POPULATION Unvaccinated women born between 1939 and 1992. MAIN OUTCOME MEASURES Optimal screening strategy in terms of incremental cost effectiveness ratios (costs per quality adjusted life years gained) compared with different cost effectiveness thresholds, for two levels of sensitivity and costs of the HPV test. RESULTS Primary HPV screening was the preferred primary test over the age of 30 in many considered scenarios. Primary cytology screening was preferred only in scenarios with low costs of cytology and in scenarios with a high prevalence of HPV in combination with high costs of HPV testing. CONCLUSIONS Most European countries should consider switching from primary cytology to HPV screening for cervical cancer. HPV screening must, however, only be implemented in situations where screening is well controlled.
Collapse
Affiliation(s)
- Inge M C M de Kok
- Erasmus MC, University Medical Center, Department of Public Health, PO Box 2040, 3000 CA Rotterdam, Netherlands.
| | | | | | | | | | | | | |
Collapse
|
85
|
Rijkaart DC, Berkhof J, van Kemenade FJ, Coupe VMH, Rozendaal L, Heideman DAM, Verheijen RHM, Bulk S, Verweij W, Snijders PJF, Meijer CJLM. HPV DNA testing in population-based cervical screening (VUSA-Screen study): results and implications. Br J Cancer 2012; 106:975-81. [PMID: 22251922 PMCID: PMC3305964 DOI: 10.1038/bjc.2011.581] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 12/07/2011] [Accepted: 12/08/2011] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) testing is more sensitive than cytology for detecting high-grade cervical intraepithelial neoplasia (CIN). We evaluated the performance of high-risk HPV (hrHPV) testing in routine screening. METHODS In all, 25,871 women (29-61) enrolled in our population-based cohort study were offered both cytology and hrHPV testing. High-risk HPV-positive women with normal cytology and an age-matched subcohort of hrHPV-negative women with normal cytology were invited for repeat testing after 1 and/or 2 years and were referred for colposcopy if they presented with abnormal cytology and/or a positive hrHPV test. The hrHPV-positive women with borderline or mild dyskaryosis (BMD) and all women with moderate dyskaryosis or worse (>BMD) were directly referred for colposcopy. Women with BMD and an hrHPV-negative test were advised to repeat cytology at 6 and 18 months and were referred for colposcopy if the repeat cytology test was abnormal. The main outcome measure was CIN grade 3 or worse (CIN3+). Results were adjusted for non-attendance at repeat testing. RESULTS The hrHPV-positive women with abnormal cytology had a CIN3+ risk of 42.2% (95% confidence interval (CI): 36.4-48.2), whereas the hrHPV-positive women with normal cytology had a much lower risk of 5.22% (95% CI: 3.72-7.91). In hrHPV-positive women with normal cytology, an additional cytology step after 1 year reduced the CIN3+ risk to only 1.6% (95% CI: 0.6-4.9) if the repeat test was normal. The CIN3+ risk in women with hrHPV-positive normal cytology was higher among women invited for the first time (29-33 years of age) (9.1%; 95% CI: 5.6-14.3) than among older women (3.0%; 95% CI: 1.5-5.5). CONCLUSION Primary hrHPV screening with cytology triage in women aged 30 years is an effective way to stratify women on CIN3+ risk and seems a feasible alternative to cytological screening. Repeat cytology after 1 year for hrHPV-positive women with normal cytology is however necessary before returning women to routine screening.
Collapse
Affiliation(s)
- D C Rijkaart
- Department of Pathology, VU University Medical Center, PO Box 7057, 1007 Amsterdam, The Netherlands
| | - J Berkhof
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - F J van Kemenade
- Department of Pathology, VU University Medical Center, PO Box 7057, 1007 Amsterdam, The Netherlands
| | - V M H Coupe
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - L Rozendaal
- Department of Pathology, VU University Medical Center, PO Box 7057, 1007 Amsterdam, The Netherlands
| | - D A M Heideman
- Department of Pathology, VU University Medical Center, PO Box 7057, 1007 Amsterdam, The Netherlands
| | - R H M Verheijen
- Division of Woman and Baby, Gynaecological Oncology, University Medical Center, Utrecht, The Netherlands
| | - S Bulk
- Department of Medical Genetics, University Medical Center, Utrecht, The Netherlands
| | - W Verweij
- SALTRO, Primary Health Care Laboratory, Utrecht, The Netherlands
| | - P J F Snijders
- Department of Pathology, VU University Medical Center, PO Box 7057, 1007 Amsterdam, The Netherlands
| | - C J L M Meijer
- Department of Pathology, VU University Medical Center, PO Box 7057, 1007 Amsterdam, The Netherlands
| |
Collapse
|
86
|
Coupé VM, Bogaards JA, Meijer CJ, Berkhof J. Impact of vaccine protection against multiple HPV types on the cost-effectiveness of cervical screening. Vaccine 2012; 30:1813-22. [DOI: 10.1016/j.vaccine.2012.01.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 12/30/2011] [Accepted: 01/02/2012] [Indexed: 11/25/2022]
|
87
|
Abstract
High-risk human papillomavirus (HPV) infection and viral persistence is a major risk factor in the development of squamous intraepithelial lesions and invasive carcinoma of the cervix. In the United States, deaths due to squamous cell carcinoma of the cervix have fallen by 75% since the 1960s because of Papanicolaou (Pap) smear screening. However, the traditional Pap had a sensitivity of about 70% for detecting clinically significant precancerous lesions and cancer because of sampling and interpretive errors. The introduction of 2 liquid-based Pap smear collection systems in the 1990s, the use of HPV testing as a triage and co-testing with Pap smear, and the introduction of 2 automated screening devices have had a significant impact on improving the detection of such precancerous lesions. This review provides an analysis of the changes in Pap smear collection, improvements in screening, the evolutionary changes of high-risk HPV testing, reporting terminology of Pap smears, and clinical management guidelines. The future impact of 2 prophylactic HPV vaccines on the incidence of cervical carcinoma is also discussed. This article also discusses alternatives such as primary screening for high-risk HPV testing with visual inspection for cervical cancer detection used in resource-poor settings with a high incidence of cervical cancer.
Collapse
|
88
|
Kulasingam S, Havrilesky L. Health economics of screening for gynaecological cancers. Best Pract Res Clin Obstet Gynaecol 2011; 26:163-73. [PMID: 22138003 DOI: 10.1016/j.bpobgyn.2011.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 10/06/2011] [Accepted: 10/21/2011] [Indexed: 12/20/2022]
Abstract
In this chapter, we summarise findings from recent cost-effectiveness analyses of screening for cervical cancer and ovarian cancer. We begin with a brief summary of key issues that affect the cost-effectiveness of screening, including disease burden, and availability and type of screening tests. For cervical cancer, we discuss the potential effect of human papilloma virus vaccines on screening. Outstanding epidemiological and cost-effectiveness issues are included. For cervical cancer, this includes incorporating the long-term effect of treatment (including adverse birth outcomes in treated women who are of reproductive age) into cost-effectiveness models using newly available trial data to identify the best strategy for incorporating human papilloma virus tests. A second issue is the need for additional data on human papilloma virus vaccines, such as effectiveness of reduced cancer incidence and mortality, effectiveness in previously exposed women and coverage. Definitive data on these parameters will allow us to update model-based analyses to include more realistic estimates, and also potentially dramatically alter our approach to screening. For ovarian cancer, outstanding issues include confirming within the context of a trial that screening is effective for reducing mortality and incorporating tests with high specificity into screening into screening algorithms for ovarian cancer.
Collapse
Affiliation(s)
- Shalini Kulasingam
- Division of Epidemiology, School of Public Health, University of Minnesota, 1300 S. 2nd St. WBOB Suite 300, Minneapolis, MN, USA.
| | | |
Collapse
|
89
|
Vanni T, Luz PM, Grinsztejn B, Veloso VG, Foss A, Mesa-Frias M, Legood R. Cervical cancer screening among HIV-infected women: an economic evaluation in a middle-income country. Int J Cancer 2011; 131:E96-104. [PMID: 21964797 DOI: 10.1002/ijc.26472] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 09/22/2011] [Indexed: 11/10/2022]
Abstract
Due to the recent widespread availability of highly active antiretroviral therapy (HAART) in middle-income countries, there has been an increase in life expectancy for women on HAART, but no corresponding decrease in cervical cancer incidence. This study evaluates the optimal cervical cancer screening strategy for HIV-infected women in a middle-income country. We developed a mathematical model, which simulates the natural history of the HPV infection, as well as the HIV-mediated immunosupression among women in Brazil. Our model was calibrated using data from the IPEC/FIOCRUZ Women's HIV-infected cohort. The model compares the lifetime effects, costs and cost-effectiveness of strategies combining cytology, HPV DNA test and colposcopy at different screening intervals for different CD4 count strata (27 strategies in total). We found that the strategy with the best cost-effectiveness profile (cost-effectiveness ratio-U$4,911/year of life saved [YLS] and probability of being cost-effective-86%) was HPV testing followed by cytology triage every year for all HIV infected women, considering a very cost-effective threshold given by Brazil's GDP per capita (US$8,625/YLS). The results were robust to changes in the input parameters as demonstrated in one-way, scenario, threshold and probabilistic sensitivity analysis. Our study indicates that annual HPV testing followed by cytology triage for all HIV-infected women is likely to be very cost-effective in a middle-income country like Brazil. The results reflect the synergic effect of using a highly sensitive screening test (HPV DNA test) in sequence with a highly specific test (cytology).
Collapse
Affiliation(s)
- Tazio Vanni
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | | | | | | | | | | | | |
Collapse
|
90
|
Ovestad IT, Vennestrøm U, Andersen L, Gudlaugsson E, Munk AC, Malpica A, Feng W, Voorhorst F, Janssen EA, Baak JP. Comparison of different commercial methods for HPV detection in follow-up cytology after ASCUS/LSIL, prediction of CIN2–3 in follow up biopsies and spontaneous regression of CIN2–3. Gynecol Oncol 2011; 123:278-83. [DOI: 10.1016/j.ygyno.2011.07.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 07/13/2011] [Accepted: 07/14/2011] [Indexed: 10/17/2022]
|
91
|
Smith JHF. Cytology, liquid-based cytology and automation. Best Pract Res Clin Obstet Gynaecol 2011; 25:585-96. [PMID: 21632286 DOI: 10.1016/j.bpobgyn.2011.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Revised: 03/31/2011] [Accepted: 04/26/2011] [Indexed: 11/15/2022]
Affiliation(s)
- John H F Smith
- Department of Histopathology and Cytology, Royal Hallamshire Hospital, Sheffield, UK.
| |
Collapse
|
92
|
Goldie SJ, Daniels N. Model-based analyses to compare health and economic outcomes of cancer control: inclusion of disparities. J Natl Cancer Inst 2011; 103:1373-86. [PMID: 21900120 PMCID: PMC3176779 DOI: 10.1093/jnci/djr303] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Revised: 07/15/2011] [Accepted: 07/19/2011] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Disease simulation models of the health and economic consequences of different prevention and treatment strategies can guide policy decisions about cancer control. However, models that also consider health disparities can identify strategies that improve both population health and its equitable distribution. METHODS We devised a typology of cancer disparities that considers types of inequalities among black, white, and Hispanic populations across different cancers and characteristics important for near-term policy discussions. We illustrated the typology in the specific example of cervical cancer using an existing disease simulation model calibrated to clinical, epidemiological, and cost data for the United States. We calculated average reduction in cancer incidence overall and for black, white, and Hispanic women under five different prevention strategies (Strategies A1, A2, A3, B, and C) and estimated average costs and life expectancy per woman, and the cost-effectiveness ratio for each strategy. RESULTS Strategies that may provide greater aggregate health benefit than existing options may also exacerbate disparities. Combining human papillomavirus vaccination (Strategy A2) with current cervical cancer screening patterns (Strategy A1) resulted in an average reduction of 69% in cancer incidence overall but a 71.6% reduction for white women, 68.3% for black women, and 63.9% for Hispanic women. Other strategies targeting risk-based screening to racial and ethnic minorities reduced disparities among racial subgroups and resulted in more equitable distribution of benefits among subgroups (reduction in cervical cancer incidence, white vs. Hispanic women, 69.7% vs. 70.1%). Strategies that employ targeted risk-based screening and new screening algorithms, with or without vaccination (Strategies B and C), provide excellent value. The most effective strategy (Strategy C) had a cost-effectiveness ratio of $28,200 per year of life saved when compared with the same strategy without vaccination. CONCLUSIONS We identify screening strategies for cervical cancer that provide greater aggregate health benefit than existing options, offer excellent cost-effectiveness, and have the biggest positive impact in worst-off groups. The typology proposed here may also be useful in research and policy decisions when trade-offs between fairness and cost-effectiveness are unavoidable.
Collapse
Affiliation(s)
- Sue J Goldie
- Department of Health Policy and Management, Center for Health Decision Science, Harvard School of Public Health, Harvard Global Health Institute, Harvard University, 718 Huntington Ave, 2nd floor, Boston, MA 02115, USA.
| | | |
Collapse
|
93
|
Goldhaber-Fiebert JD, Snowden LR, Wulczyn F, Landsverk J, Horwitz SM. Economic evaluation research in the context of Child Welfare policy: a structured literature review and recommendations. CHILD ABUSE & NEGLECT 2011; 35:722-40. [PMID: 21944552 PMCID: PMC3230248 DOI: 10.1016/j.chiabu.2011.05.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 10/28/2010] [Accepted: 05/30/2011] [Indexed: 05/25/2023]
Abstract
OBJECTIVES With over 1 million children served by the US Child Welfare system at a cost of $20 billion annually, this study examines the economic evaluation literature on interventions to improve outcomes for children at risk for and currently involved with the system, identifies areas where additional research is needed, and discusses the use of decision-analytic modeling to advance Child Welfare policy and practice. METHODS The review included 19 repositories of peer-reviewed and non-peer-reviewed "gray" literatures, including items in English published before November, 2009. Original research articles were included if they evaluated interventions based on costs and outcomes. Review articles were included to assess the relevance of these techniques over time and to highlight the increasing discussion of methods needed to undertake such research. Items were categorized by their focus on: interventions for the US Child Welfare system; primary prevention of entry into the system; and use of models to make long-term projections of costs and outcomes. RESULTS Searches identified 2,640 articles, with 49 ultimately included (19 reviews and 30 original research articles). Between 1988 and 2009, reviews consistently advocated economic evaluation and increasingly provided methodological guidance. 21 of the original research articles focused on Child Welfare, while 9 focused on child mental health. Of the 21 Child Welfare articles, 81% (17) focused on the US system. 47% (8/17) focused exclusively on primary prevention, though 83% of the US system, peer-reviewed articles focused exclusively on prevention (5/6). 9 of the 17 articles included empirical follow-up (mean sample size: 264 individuals; mean follow-up: 3.8 years). 10 of the 17 articles used modeling to project longer-term outcomes, but 80% of the articles using modeling were not peer-reviewed. Although 60% of modeling studies included interventions for children in the system, all peer-reviewed modeling articles focused on prevention. CONCLUSIONS Methodological guidance for economic evaluations in Child Welfare is increasingly available. Such analyses are feasible given the availability of nationally representative data on children involved with Child Welfare and evidence-based interventions. PRACTICE IMPLICATIONS Policy analyses considering the long-term costs and effects of interventions to improve Child Welfare outcomes are scarce, feasible, and urgently needed.
Collapse
Affiliation(s)
- Jeremy D. Goldhaber-Fiebert
- Stanford University School of Medicine, Department of Medicine, Centers for Health Policy and Primary Care and Outcomes Research, Stanford, CA
| | - Lonnie R. Snowden
- University of California, Berkeley, School of Public Health, Berkeley, CA
| | | | - John Landsverk
- Child and Adolescent Services Research Center, Rady Children’s Hospital, San Diego, CA
- School of Social Work, University of Southern California, Los Angeles, CA
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO
| | - Sarah M. Horwitz
- Stanford University School of Medicine, Department of Pediatrics and the Centers for Health Policy and Primary Care and Outcomes Research, Stanford, CA
| |
Collapse
|
94
|
Goldhaber-Fiebert JD, Snowden LR, Wulczyn F, Landsverk J, Horwitz SM. Economic evaluation research in the context of Child Welfare policy: a structured literature review and recommendations. CHILD ABUSE & NEGLECT 2011; 35:722-740. [PMID: 21944552 DOI: 10.1016/j.chiabu.2011.05.012i] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 10/28/2010] [Accepted: 05/30/2011] [Indexed: 05/27/2023]
Abstract
OBJECTIVES With over 1 million children served by the US Child Welfare system at a cost of $20 billion annually, this study examines the economic evaluation literature on interventions to improve outcomes for children at risk for and currently involved with the system, identifies areas where additional research is needed, and discusses the use of decision-analytic modeling to advance Child Welfare policy and practice. METHODS The review included 19 repositories of peer-reviewed and non-peer-reviewed "gray" literatures, including items in English published before November, 2009. Original research articles were included if they evaluated interventions based on costs and outcomes. Review articles were included to assess the relevance of these techniques over time and to highlight the increasing discussion of methods needed to undertake such research. Items were categorized by their focus on: interventions for the US Child Welfare system; primary prevention of entry into the system; and use of models to make long-term projections of costs and outcomes. RESULTS Searches identified 2,640 articles, with 49 ultimately included (19 reviews and 30 original research articles). Between 1988 and 2009, reviews consistently advocated economic evaluation and increasingly provided methodological guidance. 21 of the original research articles focused on Child Welfare, while 9 focused on child mental health. Of the 21 Child Welfare articles, 81% (17) focused on the US system. 47% (8/17) focused exclusively on primary prevention, though 83% of the US system, peer-reviewed articles focused exclusively on prevention (5/6). 9 of the 17 articles included empirical follow-up (mean sample size: 264 individuals; mean follow-up: 3.8 years). 10 of the 17 articles used modeling to project longer-term outcomes, but 80% of the articles using modeling were not peer-reviewed. Although 60% of modeling studies included interventions for children in the system, all peer-reviewed modeling articles focused on prevention. CONCLUSIONS Methodological guidance for economic evaluations in Child Welfare is increasingly available. Such analyses are feasible given the availability of nationally representative data on children involved with Child Welfare and evidence-based interventions. PRACTICE IMPLICATIONS Policy analyses considering the long-term costs and effects of interventions to improve Child Welfare outcomes are scarce, feasible, and urgently needed.
Collapse
Affiliation(s)
- Jeremy D Goldhaber-Fiebert
- Stanford University, Department of Medicine, Centers for Health Policy and Primary Care and Outcomes Research, CA 94305-6019, USA
| | | | | | | | | |
Collapse
|
95
|
Cost-effectiveness of primary HPV screening for cervical cancer in Germany – a decision analysis. Eur J Cancer 2011; 47:1633-46. [DOI: 10.1016/j.ejca.2011.03.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 03/03/2011] [Accepted: 03/04/2011] [Indexed: 11/21/2022]
|
96
|
Accetta G, Biggeri A, Carreras G, Lippi G, Carozzi FM, Confortini M, Zappa M, Paci E. Is human papillomavirus screening preferable to current policies in vaccinated and unvaccinated women? A cost-effectiveness analysis. J Med Screen 2011; 17:181-9. [DOI: 10.1258/jms.2010.010019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives Italy was the first European nation to offer free vaccination against human papillomavirus (HPV) types 16 and 18. The vaccination is actively encouraged and is available free of charge to 11-year-old girls. The introduction of new technologies such as HPV DNA testing and HPV vaccination requires cost-effectiveness analysis of cervical cancer strategies in Italy for both vaccinated and unvaccinated women. Methods A calibrated Markov model was developed to describe the natural history of HPV infection and cervical carcinogenesis. We performed a microsimulation generating the life histories of 10 million women. Changes in these life histories occur as consequences of prevention strategies. We estimated costs of screening activities using an activity-based costing analysis. We assessed lifetime risk due to cervical cancer, lifetime costs and quality-adjusted life-expectancy (QALE) for 18 scenarios. Strategies varied by screening interval (three and five years), primary and triage test (Pap test and HPV DNA test), and HPV 16 and 18 vaccination. Results The current screening policy (Pap test every three years) is more costly and less effective than HPV DNA test and Pap test triage every five years. For unvaccinated women an HPV DNA test every five years with a Pap test triage was cost-effective (ICER €5753/QALE). Vaccination followed by the same screening strategy was cost-effective (ICER €23,951/QALE) for women who are eligible to be vaccinated. Conclusions Our findings strongly support changing the Pap screening policy to the use of HPV DNA as a primary test with Pap test triage for both vaccinated and unvaccinated women.
Collapse
Affiliation(s)
- Gabriele Accetta
- Biostatistics Unit, ISPO Cancer Research and Prevention Institute, Via Cosimo il Vecchio 2, 50139 Florence, Italy
| | - Annibale Biggeri
- Department of Statistics ‘G. Parenti’, University of Florence, Italy; Director, Biostatistics Unit, ISPO Cancer Research and Prevention Institute, Via Cosimo il Vecchio 2, 50139 Florence, Italy
| | - Giulia Carreras
- Biostatistics Unit, ISPO Cancer Research and Prevention Institute, Via Cosimo il Vecchio 2, 50139 Florence, Italy
| | - Giuseppe Lippi
- Local Health Authority, Ospedale Santa Maria Annunziata, Via dell'Antella, 58, 50012 (Bagno a Ripoli) Florence, Italy
| | - Francesca Maria Carozzi
- Analytical Cytology and Biomolecular Unit, ISPO Cancer Research and Prevention Institute, Via Cosimo il Vecchio 2, 50139 Florence, Italy
| | - Massimo Confortini
- Analytical Cytology and Biomolecular Unit, ISPO Cancer Research and Prevention Institute, Via Cosimo il Vecchio 2, 50139 Florence, Italy
| | - Marco Zappa
- Unit of Clinical and Descriptive Epidemiology, ISPO Cancer Research and Prevention Institute, Via Cosimo il Vecchio 2, 50139 Florence, Italy
| | - Eugenio Paci
- Unit of Clinical and Descriptive Epidemiology, ISPO Cancer Research and Prevention Institute, Via Cosimo il Vecchio 2, 50139 Florence, Italy
| |
Collapse
|
97
|
O'Connell JM, Griffin S. Overview of methods in economic analyses of behavioral interventions to promote oral health. J Public Health Dent 2011; 71 Suppl 1:S101-18. [PMID: 21656966 PMCID: PMC4813801 DOI: 10.1111/j.1752-7325.2011.00236.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Broad adoption of interventions that prove effective in randomized clinical trials or comparative effectiveness research may depend to a great extent on their costs and cost-effectiveness (CE). Many studies of behavioral health interventions for oral health promotion and disease prevention lack robust economic assessments of costs and CE. OBJECTIVE To describe methodologies employed to assess intervention costs, potential savings, net costs, CE, and the financial sustainability of behavioral health interventions to promote oral health. METHODS We provide an overview of terminology and strategies for conducting economic evaluations of behavioral interventions to improve oral health based on the recommendations of the Panel of Cost-Effectiveness in Health and Medicine. To illustrate these approaches, we summarize methodologies and findings from a limited number of published studies. The strategies include methods for assessing intervention costs, potential savings, net costs, CE, and financial sustainability from various perspectives (e.g., health-care provider, health system, health payer, employer, society). Statistical methods for estimating short-term and long-term economic outcomes and for examining the sensitivity of economic outcomes to cost parameters are described. DISCUSSION Through the use of established protocols for evaluating costs and savings, it is possible to assess and compare intervention costs, net costs, CE, and financial sustainability. The addition of economic outcomes to outcomes reflecting effectiveness, appropriateness, acceptability, and organizational sustainability strengthens evaluations of oral health interventions and increases the potential that those found to be successful in research settings will be disseminated more broadly.
Collapse
Affiliation(s)
- Joan M O'Connell
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Denver, Aurora, CO 80045, USA.
| | | |
Collapse
|
98
|
Flores YN, Bishai DM, Lorincz A, Shah KV, Lazcano-Ponce E, Hernández M, Granados-García V, Pérez R, Salmerón J. HPV testing for cervical cancer screening appears more cost-effective than Papanicolau cytology in Mexico. Cancer Causes Control 2010; 22:261-72. [PMID: 21170578 PMCID: PMC3025113 DOI: 10.1007/s10552-010-9694-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Accepted: 11/10/2010] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To determine the incremental costs and effects of different HPV testing strategies, when compared to Papanicolau cytology (Pap), for cervical cancer screening in Mexico. METHODS A cost-effectiveness analysis (CEA) examined the specific costs and health outcomes associated with (1) no screening; (2) only the Pap test; (3) only self-administered HPV; (4) only clinician administered HPV; and (5) clinician administered HPV plus the Pap test. The costs of self- and clinician-HPV testing, as well as with the Pap test, were identified and quantified. Costs were reported in 2008 US dollars. The health outcome associated with these screening strategies was defined as the number of high-grade cervical intraepithelial neoplasia or cervical cancer cases detected. This CEA was performed using the perspective of the Mexican Institute of Social Security (IMSS) in Morelos, Mexico. RESULTS Screening women between the ages of 30-80 for cervical cancer using clinical-HPV testing or the combination of clinical-HPV testing, and the Pap is always more cost-effective than using the Pap test alone. CONCLUSIONS This CEA indicates that HPV testing could be a cost-effective screening alternative for a large health delivery organization such as IMSS. These results may help policy-makers implement HPV testing as part of the IMSS cervical cancer screening program.
Collapse
Affiliation(s)
- Yvonne N Flores
- Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, México.
| | | | | | | | | | | | | | | | | |
Collapse
|
99
|
Vanni T, Luz PM, Ribeiro RA, Novaes HMD, Polanczyk CA. [Economic evaluation in health: applications in infectious diseases]. CAD SAUDE PUBLICA 2010; 25:2543-52. [PMID: 20191146 DOI: 10.1590/s0102-311x2009001200002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Accepted: 10/27/2009] [Indexed: 01/09/2023] Open
Abstract
The rise in healthcare expenditures due to the incorporation of new diagnostic and therapeutic technologies and increasing life expectancy is a major concern, particularly in developing countries. The role of economic evaluation in health is to optimize the benefits of available resources. This article aims to allow readers to identify the basic characteristics and types of economic evaluation in health and understand its methods, with an emphasis on infectious diseases. We thus review the following concepts: study perspective, analytic scope, costs, and discount rate. We also focus on characteristics of cost-minimization, cost-effectiveness, cost-utility, and cost-benefit analyses, with examples. The article describes the most popular study designs for economic evaluation, discusses different models, and examines the importance of sensitivity analysis. Our final comments address the importance of adopting economic evaluations in health in Brazil.
Collapse
Affiliation(s)
- Tazio Vanni
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, U.K
| | | | | | | | | |
Collapse
|
100
|
Berkhof J, Bogaards JA. Vaccination against human papillomavirus types 16 and 18: the impact on cervical cancer. Future Oncol 2010; 6:1817-21. [PMID: 21142854 DOI: 10.2217/fon.10.150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|