Optimal Interval for Routine Cytologic Screening in the United States

Kim, Jane J.; Ortendahl, Jesse

doi:10.1001/2013.jamainternmed.1034

Cited by 5 publications

(3 citation statements)

References 6 publications

(7 reference statements)

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“…In contrast, screening conducted every 3 to 5 years has been shown to be associated with less than $100,000 per QALY gained. 46,48 However, all QALY analyses to date have been limited by a lack of a comprehensive set of utilities capturing women’s preferences for health states that follow from various strategies. 49…”

Section: High-value Screeningmentioning

confidence: 99%

Cervical Cancer Screening

Sawaya

Huchko

2017

Medical Clinics of North America

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Section: High-value Screeningmentioning

confidence: 99%

Cervical Cancer Screening

Sawaya

Huchko

2017

Medical Clinics of North America

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“…The data from the NMHPVPR are based on lab reports on all women screened in New Mexico from 2007 to 2011 or 2012 (depending on the specific measure) and therefore is an empirical assessment of screening practice that provides individual-level data on coverage and follow-up. A previous analysis relied on self-reported data from the NHIS (3), which is subject to recall bias and reports much greater screening intensity than the NMHPVPR, resulting in higher cost and QALY estimates (33). The prior study also did not include loss to follow-up in screen-positive women, but nonetheless yielded the same qualitative finding that current screening practice is inefficient.…”

Section: Discussionmentioning

confidence: 99%

Inefficiencies and High-Value Improvements in U.S. Cervical Cancer Screening Practice

Kim¹,

Campos²,

Sy³

et al. 2015

Ann Intern Med

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Background Studies suggest that cervical cancer screening practice in the United States is inefficient. The cost and health implications of non-compliance in the screening process compared to recommended guidelines are uncertain. Objective To estimate the benefits, costs, and cost-effectiveness of current cervical cancer screening practice and assess the value of screening improvements. Design Model-based cost-effectiveness analysis. Data Sources New Mexico HPV Pap Registry; medical literature. Target Population Cohort of women eligible for routine screening. Time Horizon Lifetime. Perspective Societal. Interventions Current cervical cancer screening practice; improved compliance to guidelines-based screening interval, triage testing, diagnostic referrals, and precancer treatment referrals. Outcome Measures Reductions in lifetime cervical cancer risk, quality-adjusted life-years (QALYs), lifetime costs, incremental cost-effectiveness ratios (ICERs), incremental net monetary benefits (INMBs Results of Base-Case Analysis Current screening practice was associated with lower health benefit and was not cost-effective relative to guidelines-based strategies. Improvements in the screening process were associated with higher QALYs and small changes in costs. Perfect c4mpliance to a 3-yearly screening interval and to colposcopy/biopsy referrals were associated with the highest INMBs ($759 and $741, respectively, at a willingness-to-pay threshold of $100,000 per QALY gained); together, the INMB increased to $1,645. Results of Sensitivity Analysis Current screening practice was inefficient in 100% of simulations. The rank ordering of screening improvements according to INMBs was stable over a range of screening inputs and willingness-to-pay thresholds. Limitations The impact of HPV vaccination was not considered. Conclusions The added health benefit of improving compliance to guidelines, especially the 3-yearly interval for cytology screening and diagnostic follow-up, may justify additional investments in interventions to improve U.S. cervical cancer screening practice. Funding Source U.S. National Cancer Institute.

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“…Cervical cancer screening in the United States can be improved by reducing the frequency of screening intervals for over-screened women to be consistent with guidelines, and directing realized savings toward increasing screening among rarely or never-screened women ( Kim et al, 2013 ). We found that screening interval recommendations were dictated not by provider demographics but by positive beliefs regarding longer screening intervals.…”

Section: Discussionmentioning

confidence: 99%

Provider beliefs associated with cervical cancer screening interval recommendations: A pilot study in Federally Qualified Health Centers

Roland

Greek

Hawkins

et al. 2015

Preventive Medicine Reports

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BackgroundAmong providers who serve low-income and uninsured women, resistance to extending the cervical cancer screening interval following normal Pap and co-test results has been documented. Our objective was to examine provider characteristics and beliefs associated with guideline-consistent screening interval recommendations.MethodWe collected cross-sectional survey data between 2009 and 2010 from 82 primary care providers in six Federally Qualified Health Centers in Illinois, USA. The relationships between characteristics, beliefs, and screening interval recommendations (1 year vs. 3 years) were tested with Pearson chi-square, negative binomial and ordered logistic regression.ResultsCompared to providers who recommended annual intervals after a normal co-test, providers who recommended a guideline-consistent (i.e., 3 years) screening interval were significantly more likely to report the goodness, ease, and benefit of their recommendation and perceived encouragement for a 3-year interval from professional organizations and journals (p < .05). Providers who recommended a 3-year interval were also less likely to report that longer intervals increase patient risk for cervical cancer (p < .05). Interval recommendations were not associated with provider specialty, gender, or years in practice.ConclusionMessages that promote the benefits of longer screening intervals after a normal co-test, the natural history of human papillomavirus and cervical cancer, and low risk of developing cancer with a longer interval may be useful to promote evidence-based screening in this population of Federally Qualified Health Center providers. Dissemination of targeted messages through professional journals and specialty organizations should be considered.

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Optimal Interval for Routine Cytologic Screening in the United States

Cited by 5 publications

References 6 publications

Cervical Cancer Screening

Cervical Cancer Screening

Inefficiencies and High-Value Improvements in U.S. Cervical Cancer Screening Practice

Provider beliefs associated with cervical cancer screening interval recommendations: A pilot study in Federally Qualified Health Centers

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