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Malagón T, Mayrand MH, Ogilvie G, Gotlieb WH, Blake J, Bouchard C, Franco EL, Kulasingam S. Modeling the Balance of Benefits and Harms of Cervical Cancer Screening with Cytology and Human Papillomavirus Testing. Cancer Epidemiol Biomarkers Prev 2020; 29:1436-1446. [PMID: 32332032 DOI: 10.1158/1055-9965.epi-20-0190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/03/2020] [Accepted: 04/16/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Benefits of screening should outweigh its potential harms. We compared various metrics to assess the balance of benefits and harms of cervical cancer screening. METHODS We used a cervical cancer natural history Markov model calibrated to the Canadian context to simulate 100,000 unvaccinated women over a lifetime of screening with either cytology every 3 years or human papillomavirus (HPV) testing every 5 years. We estimated the balance of benefits and harms attributable to screening using various metrics, including colposcopies/life-year gained, and net lifetime quality-adjusted life-years (QALY) gained, a measure integrating women's health preferences. We present the average (minimum-maximum) model predictions. RESULTS Cytology-based screening led to 1,319,854 screening tests, 30,395 colposcopies, 13,504 life-years gained over a lifetime, 98 screening tests/life-year gained, 2.3 (1.6-3.3) colposcopies/life-year gained, and a net lifetime gain of 10,735 QALY (5,040-17,797). HPV-based screening with cytology triage in the same population would lead to 698,250 screening tests, 73,296 colposcopies, 15,066 life-years gained over a lifetime, 46 screening tests/life-year gained, 4.9 colposcopies/life-year gained (2.9-11.1), and a net lifetime gain of 11,690 QALY (4,409-18,742). HPV-based screening was predicted to prevent more cancers, but also incur more screening harms than cytology-based screening. CONCLUSIONS Metrics using colposcopies as the main harm outcome favored cytology-based screening, whereas metrics based on screening tests and health preferences tended to favor HPV-based screening strategies. IMPACT Whether HPV-based screening will improve the balance between benefits and harms of cervical cancer screening depends on how the balance between benefits and harms is assessed.
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Affiliation(s)
- Talía Malagón
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Quebec, Canada.
| | - Marie-Hélène Mayrand
- Departments of Obstetrics and Gynecology and Social and Preventive Medicine, Université de Montréal et CRCHUM, Montreal, Quebec, Canada
| | - Gina Ogilvie
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Walter H Gotlieb
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Jennifer Blake
- Society of Obstetricians and Gynaecologists of Canada, Ottawa, Ontario, Canada
| | - Céline Bouchard
- Centre Hospitalier Universitaire de Québec, Québec City, Quebec, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Quebec, Canada
| | - Shalini Kulasingam
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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Defining ranges for certainty ratings of diagnostic accuracy: a GRADE concept paper. J Clin Epidemiol 2020; 117:138-148. [DOI: 10.1016/j.jclinepi.2019.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 04/07/2019] [Accepted: 05/14/2019] [Indexed: 12/11/2022]
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Ock M, Park JY, Son WS, Lee HJ, Kim SH, Jo MW. Estimation of utility weights for human papilloma virus-related health states according to disease severity. Health Qual Life Outcomes 2016; 14:163. [PMID: 27894347 PMCID: PMC5126850 DOI: 10.1186/s12955-016-0566-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 11/23/2016] [Indexed: 12/23/2022] Open
Abstract
Background A cost-utility study of a human papilloma virus (HPV) vaccine requires that the utility weights for HPV-related health states (i.e., cervical intraepithelial neoplasia (CIN), cervical cancer, and condyloma) be evaluated. The aim of the present study was to determine the utility weights for HPV-related health states. Methods Hypothetical standardised health states related to HPV were developed based on patient education material and previous publications. To fully reflect disease progression from diagnosis to prognosis, each health state comprised four parts (diagnosis, symptoms, treatment, and progression and prognosis). Nine-hundred members from the Korean general population evaluated the HPV-related health states using a visual analogue scale (VAS) and a standard gamble (SG) approach, which were administered face-to-face via computer-assisted interview. The mean utility values were calculated for each HPV-related health state. Results According to the VAS, the highest utility (0.73) was HPV-positive status, followed by condyloma (0.66), and CIN grade I (0.61). The lowest utility (0.18) was cervical cancer requiring chemotherapy without surgery, followed by cervical cancer requiring chemoradiation therapy (0.42). SG revealed that the highest utility (0.83) was HPV-positive status, followed by condyloma (0.78), and CIN grade I (0.77). The lowest utility (0.43) was cervical cancer requiring chemotherapy without surgery, followed by cervical cancer requiring chemoradiation therapy (0.60). Conclusions This study was based on a large sample derived from the general Korean population; therefore, the calculated utility weights might be useful for evaluating the economic benefit of cancer screening and HPV vaccination programs. Electronic supplementary material The online version of this article (doi:10.1186/s12955-016-0566-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Minsu Ock
- Department of Preventive Medicine, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, South Korea
| | - Jeong-Yeol Park
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Woo-Seung Son
- Department of Preventive Medicine, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, South Korea
| | - Hyeon-Jeong Lee
- Department of Preventive Medicine, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, South Korea
| | - Seon-Ha Kim
- Department of Nursing, College of Nursing, Dankook University, Cheonan, South Korea
| | - Min-Woo Jo
- Department of Preventive Medicine, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, South Korea.
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Abstract
Recent changes in cervical cancer screening and management guidelines reflect our evolving knowledge about cervical carcinogenesis. In the pursuit of precision, however, decision-making has become complicated. We provide an overview of cervical cancer screening with a focus on what clinicians can do to maximize screening benefits while minimizing screening harms. The approach relies on categorizing women at each step in the screening process by their estimated risk of high-grade precancerous lesions and cervical cancer. Current screening guidelines are designed to find a reasonable balance between benefits and harms by recommending less screening in most women. Current management guidelines are designed to assure consistent decisions regarding referral to colposcopy. After initial colposcopy, we outline three major management options based on risk assessment. For treatment, we recommend ablational procedures when appropriate because they are similarly effective, less costly, and potentially safer than excisional procedures. We advise caution in adopting new screening strategies until they demonstrate cost-effective patient-centered improvements compared with current strategies. Clinicians can maximize their effect on cervical cancer prevention by being attentive to guidelines, assuring that women have access to appropriate human papillomavirus vaccination and providing low-cost, high-quality screening and treatment.
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Kuppermann M, Norton ME, Thao K, O'Leary A, Nseyo O, Cortez A, Kaimal AJ. Preferences regarding contemporary prenatal genetic tests among women desiring testing: implications for optimal testing strategies. Prenat Diagn 2016; 36:469-75. [DOI: 10.1002/pd.4808] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 02/28/2016] [Accepted: 03/01/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Miriam Kuppermann
- Department of Obstetrics, Gynecology, and Reproductive Sciences; University of California; San Francisco CA USA
- Department of Epidemiology and Biostatistics; University of California; San Francisco CA USA
| | - Mary E. Norton
- Department of Obstetrics, Gynecology, and Reproductive Sciences; University of California; San Francisco CA USA
| | - Kao Thao
- Department of Obstetrics, Gynecology, and Reproductive Sciences; University of California; San Francisco CA USA
| | - Allison O'Leary
- Department of Obstetrics, Gynecology, and Reproductive Sciences; University of California; San Francisco CA USA
| | - Onouwem Nseyo
- Department of Obstetrics, Gynecology, and Reproductive Sciences; University of California; San Francisco CA USA
| | - Abigail Cortez
- Department of Obstetrics, Gynecology, and Reproductive Sciences; University of California; San Francisco CA USA
| | - Anjali J. Kaimal
- Department of Obstetrics and Gynecology; Massachusetts General Hospital; Boston MA USA
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Li YK, Alolabi N, Kaur MN, Thoma A. A systematic review of utilities in hand surgery literature. J Hand Surg Am 2015; 40:997-1005. [PMID: 25771479 DOI: 10.1016/j.jhsa.2015.01.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 01/14/2015] [Accepted: 01/15/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To systematically review the literature to determine if utilities (a quantitative way to express patient preferences for health outcomes) have been measured in hand surgery studies. METHODS A literature search was conducted using Cochrane, EMBASE, HealthSTAR, MEDLINE, and CINAHL electronic databases (1966-2013). This search was supplemented by cited and manual reference searches and expert consultation to retrieve all relevant studies. Studies were selected by 2 independent reviewers if they pertained to hand or wrist surgery, were published in English, and measured utilities as an outcome. Descriptive data were extracted, including the hand surgery procedure investigated, study design, value of utilities, and methodology of utilities measurement. RESULTS Eleven studies were included after reviewing 989 studies. Most hand conditions were associated with utilities less than 0.8. Utilities in the reviewed studies were measured using different methods and from different subjects. Three studies paradoxically mapped greater utilities for poorer heath states. CONCLUSIONS Hand conditions cause impairment, as evidenced by their utilities. Measurement of utilities remains uncommon in hand surgery literature. Future studies should not only measure utilities but also do so with consistent and appropriate methodology to ensure that mapped values are valid and comparable. TYPE OF STUDY/LEVEL OF EVIDENCE Economic/decision analysis III.
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Affiliation(s)
- Yu Kit Li
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Surgical Outcomes Research Centre, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Noor Alolabi
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Surgical Outcomes Research Centre, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Manraj Nirmal Kaur
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Surgical Outcomes Research Centre, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Achilleas Thoma
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Surgical Outcomes Research Centre, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
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Patient preferences for side effects associated with cervical cancer treatment. Int J Gynecol Cancer 2015; 24:1077-84. [PMID: 24905618 DOI: 10.1097/igc.0000000000000149] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess patient preferences regarding side effects associated with cervical cancer treatment. METHODS/MATERIALS The visual analog scale (VAS) and modified standard gamble (SG) were used to elicit preferences of women with no evidence of disease after primary treatment of cervical cancer. Higher scores on VAS and SG indicated more favorable ratings for a given health state. Health states (HS) included vaginal shortening, diarrhea, dietary changes, menopause, moderate nausea/vomiting, rectal bleeding, sexual dysfunction, and urinary self-catheterization. Descriptive statistics, Kruskal-Wallis, Mann-Whitney U, and Wilcoxon signed-ranks tests and correlation coefficients were used for statistical analysis. RESULTS Seventy-eight patients participated in the study. Median age was 44.1 years (range, 24.9-67.8 years). Median time since treatment completion was 31.2 months (range, 1.0-113.3 months). The HSs rated as most favorable by VAS were also rated as most favorable by SG. Increasing age was associated with higher VAS scores for menopause and vaginal shortening (P = 0.04 and 0.036). African Americans had higher VAS scores for dietary changes (P = 0.05), sexual dysfunction (P = 0.028), and diarrhea (P = 0.05) when compared with Hispanic and non-Hispanic white patients. Women receiving radiation had more favorable VAS scores for menopause compared with women undergoing radical hysterectomy (P = 0.05). Women receiving chemotherapy rated urinary self-catheterization less favorably by VAS score compared with those not receiving chemotherapy (P = 0.045). CONCLUSIONS Multiple demographic and clinical factors influence the severity of treatment-related adverse effects perceived by women surviving cervical cancer. A better understanding of factors influencing patient preferences regarding treatment side effects will allow providers to formulate care better tailored to the individual desires of each patient.
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Simonella L, Howard K, Canfell K. A survey of population-based utility scores for cervical cancer prevention. BMC Res Notes 2014; 7:899. [PMID: 25495005 PMCID: PMC4307910 DOI: 10.1186/1756-0500-7-899] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 10/24/2014] [Indexed: 11/30/2022] Open
Abstract
Background With human papillomavirus (HPV) vaccination introduced in a number of countries, there is considerable interest in evaluating the cost-effectiveness of HPV testing as the primary cervical screening test in these settings. However, the availability of utility scores for these newer interventions is limited. Our aim in this paper is to present utility scores for HPV vaccination, HPV testing and cytology based screening states among women targeted for cervical screening. Methods We invited a random sample of women targeted for cervical screening (aged 20-69 years) living in Sydney, Australia, to participate in a face-to-face interview. Participants were asked to indicate preferences (rank and utility scores) for 10 hypothetical health states relating to HPV vaccination, cytology and primary HPV screening, cervical precursor disease and early stage cervical cancer. Preferences for hypothetical health states were measured through ranking then a two-stage standard gamble. Each participant’s own health state was measured as a utility score using the EQ5D. Potential differences by age were assessed using the Wilcox Rank Sum test. Results A maximum of 276 women were contacted, of which 43 (mean age 49 years) agreed to be interviewed (15.6%). The overall health state of women as measured by the EQ5D was 0.86 (95% CI: 0.83-0.89). Of the 10 health states, the highest ranked were ‘normal cytology’ and ‘HPV vaccination’ (equal 1st). States involving an HPV positive result with a subsequent normal cytology or colposcopy were ranked below those for low grade cytological abnormalities with or without a subsequent colposcopic normal result (ranks 3-4 vs. 4-5). However, mean utility scores were broadly similar for all health states, except cervical cancer. No significant differences in scores were identified between age groups. Conclusion Our survey suggests health states relating to HPV testing are ranked below ‘low grade cytology’ disease abnormalities. However, this difference was minimal on the utility scale, as most values for health states were largely clustered. These results provide a preliminary set of non-clinic population-based utilities that may be used with other values to explore the economic implications of introducing HPV testing as a primary screening tool in the context of HPV vaccination. Electronic supplementary material The online version of this article (doi:10.1186/1756-0500-7-899) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, Australia.
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Kokorowski PJ, Routh JC, Borer JG, Estrada CR, Bauer SB, Nelson CP. Screening for Malignancy After Augmentation Cystoplasty in Children With Spina Bifida: A Decision Analysis. J Urol 2011; 186:1437-43. [DOI: 10.1016/j.juro.2011.05.065] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Indexed: 11/25/2022]
Affiliation(s)
- Paul J. Kokorowski
- Department of Urology, Children's Hospital Boston and Harvard Pediatric Health Services Research Fellowship Program (JCR), Harvard Medical School, Boston, Massachusetts
| | - Jonathan C. Routh
- Department of Urology, Children's Hospital Boston and Harvard Pediatric Health Services Research Fellowship Program (JCR), Harvard Medical School, Boston, Massachusetts
| | - Joseph G. Borer
- Department of Urology, Children's Hospital Boston and Harvard Pediatric Health Services Research Fellowship Program (JCR), Harvard Medical School, Boston, Massachusetts
| | - Carlos R. Estrada
- Department of Urology, Children's Hospital Boston and Harvard Pediatric Health Services Research Fellowship Program (JCR), Harvard Medical School, Boston, Massachusetts
| | - Stuart B. Bauer
- Department of Urology, Children's Hospital Boston and Harvard Pediatric Health Services Research Fellowship Program (JCR), Harvard Medical School, Boston, Massachusetts
| | - Caleb P. Nelson
- Department of Urology, Children's Hospital Boston and Harvard Pediatric Health Services Research Fellowship Program (JCR), Harvard Medical School, Boston, Massachusetts
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Melnikow J, Kulasingam S, Slee C, Helms LJ, Kuppermann M, Birch S, McGahan CE, Coldman A, Chan BKS, Sawaya GF. Surveillance after treatment for cervical intraepithelial neoplasia: outcomes, costs, and cost-effectiveness. Obstet Gynecol 2010; 116:1158-70. [PMID: 20966702 DOI: 10.1097/aog.0b013e3181f88e72] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate outcomes and costs of surveillance strategies after treatment for high-grade cervical intraepithelial neoplasia (CIN). METHODS A hypothetical cohort of women was evaluated after treatment for CIN 2 or 3 using a Markov model incorporating data from a large study of women treated for CIN, systematic reviews of test accuracy, and individual preferences. Surveillance strategies included initial conventional or liquid-based cytology, human papillomavirus testing, or colposcopy 6 months after treatment, followed by annual or triennial cytology. Estimated outcomes included CIN, cervical cancer, cervical cancer deaths, life expectancy, costs, cost per life-year, and cost per quality-adjusted life-year. RESULTS Conventional cytology at 6 and 12 months, followed by triennial cytology, was least costly. Compared with triennial cytology, annual cytology follow-up reduced expected cervical cancer deaths by 73% to 77% and had an average incremental cost per life-year gained of $69,000 to $81,000. For colposcopy followed by annual cytology, the incremental cost per life-year gained ranged from $70,000 to more than $1 million, depending on risk. Between-strategy differences in mean additional life expectancy per woman were less than 4 days; differences in mean incremental costs per woman were as high as $822. In the cost-utility analysis, colposcopy at 6 months followed by annual cytology had an incremental cost per quality-adjusted life-year of less than $5,500. Human papillomavirus testing or liquid-based cytology added little to no improvement to life-expectancy with higher costs. CONCLUSION Annual conventional cytology surveillance reduced cervical cancers and cancer deaths compared with triennial cytology. For high risk of recurrence, a strategy of colposcopy at 6 months increased life expectancy and quality-adjusted life expectancy. Human papillomavirus testing and liquid-based cytology increased costs, but not effectiveness, compared with traditional approaches.
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Affiliation(s)
- Joy Melnikow
- Department of Economics, Center for Healthcare Policy and Research, University of California, Davis, California 95817, USA.
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