An economic analysis of human papillomavirus triage for the management of women with atypical and abnormal Pap smear results in Germany

We developed decision-analytic models to determine the cost effectiveness of incorporating human papillomavirus (HPV) testing into the management of atypical and abnormal Pap smear results in Germany. The models compare three management strategies: (1) repeat Pap smear, (2) triage with HPV DNA testing, or (3) immediate treatment. The primary outcome measure is incremental cost per case of cervical intraepithelial neoplasia (CIN) 2+ detected and treated. The models take the perspective of the German health system. For patients with initial PapIIw, III, and IIId results, incremental cost effectiveness ratios for HPV triage versus repeat Pap smears are 2,232 euro, 815 euro, and 487 euro per additional case of CIN2+ detected and treated. In addition, the number of cases of CIN2+ detected and treated in a hypothetical population of 1,000 women increases from 17 to 35, 61 to 130, and 157 to 332 for each population, respectively. For patients with initial PapIII and IIId results, immediate treatment of 1,000 patients detects only four and 11 additional cases of CIN2+ versus HPV triage at incremental cost effectiveness ratios of 39,684 euro and 10,716 euro per case, respectively. For each of the populations evaluated, HPV triage is the most cost-effective management strategy versus either repeat Pap smear or immediate treatment.

Lifestyle Correlates of Health Perception and Treatment Satisfaction in a Clinical Cohort of Men with Prostate Cancer

There is a growing need to understand how nutritional and lifestyle practices may optimize quality of life (QOL) and health after diagnosis for the 1.5 million men living with prostate cancer in the United States. We are establishing a clinical cohort of men with prostate cancer at the University of California San Francisco. Men completed detailed dietary and lifestyle questionnaires annually and provided consent for blood and tissue specimens to be stored for research if they underwent radical prostatectomy. We examined the feasibility of establishing this cohort and analyzepreliminary baseline data on participant demographics, lifestyle habits, and QOL using c2 and t-tests and logistic regression models. Between February 2002 and July 2004, we enrolled 343 men with prostate cancer into the survey portion of this cohort. The response rate was approximately 85% via in-clinic enrollment and 30% via mail enrollment. Based on analysis of the first 193 men enrolled, there was a high level of treatment satisfaction in this population (88% of men were satisfied or extremely satisfied with treatment) and positive reports of general health perception (73% of men perceived themselves to be in excellent [34%] or very good [39%] health). Whether treatment interfered with diet was an independent predictor of health perception and treatment satisfaction. Use of dietary supplements was high (90%) in this well-educated population. In conclusion, we demonstrated good feasibility for conducting this longitudinal study and observed initial indications that diet and other lifestyle practices were important predictors of patient QOL.

Economic evaluation of a 2-dose hepatitis B vaccination regimen for adolescents

OBJECTIVE

To investigate the economic implications of a 2-dose hepatitis B virus vaccination regimen compared with the current 3-dose vaccination regimen for adolescents in 3 settings: public schools, public health clinics, and private sector settings in the United States.

METHODS

To measure resource utilization and costs associated with the administration of the 3-dose regimen and to assess vaccination compliance rates with this regimen, primary data were collected with the use of questionnaires tailored for each setting. Conservative modeling assumptions were used to derive 2-dose compliance rates from 3-dose compliance data. The results were incorporated into a decision analytic model, which was used to examine short-term and lifetime scenarios for an adolescent cohort receiving the 2-dose versus the 3-dose regimen. In the short-term analysis, the vaccination program costs were compared for the 2 regimens. In the lifetime analysis, the model also incorporated long-term disease costs for those individuals who contract hepatitis B.

RESULTS

Predicted increases in compliance with a 2-dose vaccination regimen contributed to a higher probability of seroprotection in each setting. In the lifetime analysis, this positive impact of improved compliance resulted in a lower infection rate and greater cost-effectiveness for the 2-dose regimen in all settings, including private sector settings, where it cost an average of only $964 per year of life gained, and in public schools, costing an average of $1246 per year of life gained. In public health clinics, the 2-dose regimen had both lower expected lifetime costs and better clinical outcomes than the 3-dose regimen. In the short-term analysis, costs were higher for the 2-dose regimen, reflecting higher total vaccine acquisition costs without the long-term offset of cost savings from reduced infection. Sensitivity analyses identified cost per dose of vaccine and the probability of completing the regimens as the most sensitive model variables.

CONCLUSIONS

Improved compliance with a 2-dose regimen would contribute to a higher probability of adolescents' achieving seroprotection. When the long-term consequences of hepatitis B virus infection are included, the 2-dose regimen would be cost-effective compared with the 3-dose regimen in all settings and cost saving in public health clinic settings.