 |
|
Cost-effectiveness of 3 Methods to Enhance the Sensitivity of Papanicolaou Testing
Adalsteinn D. Brown;
Alan M. Garber, MD, PhD
JAMA. 1999;281:347-353.
Context ThinPrep, AutoPap, and Papnet are 3 new technologies that increase the sensitivity and cost of cervical cancer screening.
Objective To estimate the cost-effectiveness of these technological enhancements to Papanicolaou (Pap) tests.
Design We estimated the increase in sensitivity from using these technologies by combining results of 8 studies meeting defined criteria. We used published literature and additional sources for cost estimates. To estimate overall cost-effectiveness, we applied a 9-state time-varying transition state model to these data and information about specific populations.
Setting A hypothetical program serving a cohort of 20- to 65-year-old women who begin screening at the same age and are representative of the US population.
Results The new technologies increased life expectancy by 5 hours to 1.6 days, varying with the technology and the frequency of screening. All 3 technologies also increased the cost per woman screened by $30 to $257 (1996 US dollars). AutoPap dominated ThinPrep in the base case. At each screening interval, AutoPap increased survival at the lowest cost. The cost per year of life saved rose from $7777 with quadrennial screening to $166,000 with annual screening. Papnet produced more life-years at a higher cost per year of life saved. However, when used with triennial screening, each of them produced more life-years at lower cost than conventional Pap testing every 2 years. The cost-effectiveness ratio of each technology improved with increases in the prevalence of disease, decreases in the sensitivity of conventional Pap testing, and increases in the improvement in sensitivity produced by the technology.
Conclusions Technologies to increase the sensitivity of Pap testing are more cost-effective when incorporated into infrequent screening. Increases in sensitivity and decreases in cost may eventually make each technology more cost-effective.
Author Affiliations: Department of Public Health and Primary Care, University of Oxford, Oxford, England (Mr Brown), and Veterans Affairs Palo Alto Health Care System and Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, Calif (Dr Garber). Mr Brown is now with the Department of Epidemiology and Biostatistics and Department of Family Medicine, University of Western Ontario, London.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
RELATED LETTERS
Cost-effectiveness of Methods to Enhance Sensitivity of Papanicolaou Testing
Nancy Kline Leidy, Ruth Brown, Bryan Luce, Ellen Sheets, Thomas V. Sedlacek, Adalsteinn D. Brown, and Alan M. Garber
JAMA. 1999;282(15):1419-1420.
EXTRACT
| FULL TEXT
Cost-effectiveness of Alternative Triage Strategies for Atypical Squamous Cells of Undetermined Significance
Jane J. Kim, Thomas C. Wright, and Sue J. Goldie
JAMA. 2002;287(18):2382-2390.
ABSTRACT
| FULL TEXT
RELATED ARTICLE
January 27, 1999
JAMA. 1999;281(4):391-392.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
The German Cervical Cancer Screening Model: development and validation of a decision-analytic model for cervical cancer screening in Germany
Siebert et al.
Eur J Public Health 2006;16:185-192.
ABSTRACT
| FULL TEXT
The Cost-Effectiveness of Screening Programs Using Single and Multiple Birth Cohort Simulations: A Comparison Using a Model of Cervical Cancer
Dewilde and Anderson
Med Decis Making 2004;24:486-492.
ABSTRACT
Projected Clinical Benefits and Cost-effectiveness of a Human Papillomavirus 16/18 Vaccine
Goldie et al.
JNCI J Natl Cancer Inst 2004;96:604-615.
ABSTRACT
| FULL TEXT
Potential Health and Economic Impact of Adding a Human Papillomavirus Vaccine to Screening Programs
Kulasingam and Myers
JAMA 2003;290:781-789.
ABSTRACT
| FULL TEXT
Chapter 15: Public Health Policy and Cost-Effectiveness Analysis
Goldie
J Natl Cancer Inst Monogr 2003;2003:102-110.
ABSTRACT
| FULL TEXT
Costs and Benefits of Different Strategies to Screen for Cervical Cancer in Less-Developed Countries
Mandelblatt et al.
JNCI J Natl Cancer Inst 2002;94:1469-1483.
ABSTRACT
| FULL TEXT
Benefits and Costs of Using HPV Testing to Screen for Cervical Cancer
Mandelblatt et al.
JAMA 2002;287:2372-2381.
ABSTRACT
| FULL TEXT
Cost-effectiveness of Alternative Triage Strategies for Atypical Squamous Cells of Undetermined Significance
Kim et al.
JAMA 2002;287:2382-2390.
ABSTRACT
| FULL TEXT
American Cancer Society Guidelines for the Early Detection of Cancer
Smith et al.
CA Cancer J Clin 2002;52:8-22.
ABSTRACT
| FULL TEXT
Does Cost-Effectiveness Analysis Make a Difference?: Lessons from Pap Smears
Hagen et al.
Med Decis Making 2001;21:307-323.
Current Approaches to Cervical-Cancer Screening
Sawaya et al.
NEJM 2001;344:1603-1607.
FULL TEXT
Ambulatory Gynecology
Peipert
JAMA 2000;283:2630-2632.
FULL TEXT
Cost-effectiveness of Methods to Enhance Sensitivity of Papanicolaou Testing
Leidy et al.
JAMA 1999;282:1419-1420.
FULL TEXT
|
