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- Bistoletti, P., et al.
(författare)
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Cost-effectiveness of primary cytology and HPV DNA cervical screening
- 2008
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Ingår i: International Journal of Cancer. - : Wiley. - 0020-7136 .- 1097-0215. ; 122:2, s. 372-376
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Tidskriftsartikel (refereegranskat)abstract
- Because cost-effectiveness of different cervical cytology screening strategies with and without human papillomavirus (HPV) DNA testing is unclear, we used a Markov model to estimate life expectancy and health care cost per woman during the remaining lifetime for 4 screening strategies: (i) cervical cytology screening at age 32, 35, 38, 41, 44, 47, 50, 55 and 60, (ii) same strategy with addition of testing for HPV DNA persistence at age 32, (iii) screening with combined cytology and testing for HPV DNA persistence at age 32, 41 and 50, iv) no screening. Input data were derived from population-based screening registries, health-service costs and from a population-based HPV screening trial. Impact of parameter uncertainty was addressed using probabilistic multivariate sensitivity analysis. Cytology screening between 32 and 60 years of age in 3-5 year intervals increased life expectancy and life-time costs were reduced from 533 to 248 US Dollars per woman compared to no screening. Addition of HPV DNA testing, at age 32 increased costs from 248 to 284 US Dollars without benefit on life expectancy. Screening with both cytology and HPV DNA testing, at ages 32, 41 and 50 reduced costs from 248 to 210 US Dollars with slightly increased life expectancy. In conclusion, population-based, organized cervical cytology screening between ages 32 to 60 is highly cost-efficient for cervical cancer prevention. If screening intervals are increased to at least 9 years, combined cytology and HPV DNA screening appeared to be still more effective and less costly. © 2007 Wiley-Liss, Inc.
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- Bistoletti, Peter, et al.
(författare)
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En hälsoekonomisk modellstudie av primärscreening mot livmoderhalscancer med cellprov- och HPV DNA-test
- 2008
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Livmoderhalscancer är en ovanlig cancersjukdom i Sverige. Sjukdomen är ändå ett allvarligt hälsoproblem då den ofta drabbar relativt unga kvinnor och kan leda till döden. Inte minst tack vare införande av regelbundna hälsokontroller med tidigare upptäckt av sjukdomen som följd så har dödligheten minskat en lång period. Betydelsen av organiserad screening har dock ifrågasatts då programmet aldrig blev föremål för någon adekvat utvärdering innan det startade.Nu står vi inför nya medicinska och sjukvårdpolitiska frågeställningar rörande åtgärder för att förebygga livmoderhalscancer. Det vetenskapligt fastställda sambandet mellan förekomst av HPV (Humant Papillomavirus) och livmoderhalscancer har bland annat inneburit framtagning av ett vaccin mot vissa typer av HPV med en livlig debatt rörande utformning av det nationella vaccinationsprogrammet. Vidare finns det nya tester för att upptäcka förekomst av HPV hos kvinnor som kan kombineras med och eventuellt ersätta nuvarande cellprov. Det är komplicerat att bestämma vilken strategi som är bäst då det i praktiken är empiriskt omöjligt att utvärdera alla tänkbara alternativ i traditionella kliniska studier. Förutsättningarna förändras också hela tiden när nya teknologier aktualiseras. Detta ställer krav på analyser som samlar bästa tillgängliga information på ett systematiskt sätt för att belysa olika konsekvenser med de data som finns idag.Denna rapport presenterar en modellanalys som gjorts av docent Peter Bistoletti och fil dr Karin Sennfält. De har genomfört analysen tillsammans med flera av Sveriges ledande experter inom detta område. Vid tidpunkten för studien var Peter och Karin verksamma vid Centrum för utvärdering av medicinsk teknologi (CMT), Institutionen för hälsa och samhälle (IHS), Linköpings Universitet.Arbetet har finansierats av Landstinget i Östergötland, Cancerfonden, och från EU.Linköping september 2007Per Carlsson, professor
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- Sandblom, G, et al.
(författare)
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A population-based study of pain and quality of life during the year before death in men with prostate cancer
- 2004
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Ingår i: British Journal of Cancer. - : Springer Science and Business Media LLC. - 0007-0920 .- 1532-1827. ; 90:6, s. 1163-1168
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Tidskriftsartikel (refereegranskat)abstract
- In order to explore how health-related quality of life changes towards the end of life, a questionnaire including the EuroQOI form and the Brief Pain Inventory form was sent to all men with prostate cancer in the county of Östergötland, Sweden, in September 1999. Responders who had died prior to 1 January 2001 were later identified retrospectively. Of the 1442 men who received the questionnaire, 1243 responded (86.2%). In the group of responders, 167 had died within the study period, 66 of prostate cancer. In multivariate analysis, pain as well as death within the period of study were found to predict decreased quality of life significantly. Of those who died of prostate cancer, 29.0% had rated their worst pain the previous week as severe. The same figure for those still alive was 10.5%. On a visual analogue scale (range 0-100), the mean rating of quality of life for those who subsequently died of prostate cancer was 54.0 (95% confidence interval ±5.2) and those still alive was 70.0 (±1.2). In conclusion, hearth-related quality of life gradually declines during the last year of life in men with prostate cancer. This decline may partly be avoided by an optimised pain management. © 2004 Cancer Research UK.
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- Sennfält, Karin, 1963-, et al.
(författare)
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Comparison of hemodialysis and peritoneal dialysis - A cost-utility analysis
- 2002
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Ingår i: Peritoneal Dialysis International. - 0896-8608 .- 1718-4304. ; 22:1, s. 39-47
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Tidskriftsartikel (refereegranskat)abstract
- ? Objective: Our aim was to compare both health-related quality of life and costs for hemodialysis (HD) and peritoneal dialysis (PD) in a defined population. ? Design: Decision-tree modeling to estimate total costs and effects for two treatment strategies, HD and PD, among patients with chronic kidney failure, for 5 years following the start of treatment. Courses of events and health-care consumption were mapped in a retrospective matched-record study. Data on health status were obtained from a matched population by a quality-of-life questionnaire (EuroQol). The study has a societal perspective. ? Setting: All dialysis departments in the southeastern health-care region of Sweden. ? Patients: 136 patients with kidney failure, comprising 68 matched pairs, were included in a retrospective record study, 81 patients with kidney failure, comprising 27 matched triplets, were included in a prospective questionnaire study. ? Main Outcome Measures: Cost per life year and cost per quality-adjusted life year. ? Results: The cost per quality-adjusted life year for PD was lower in all analyzed age groups. There was a 12% difference in the age group 21 - 40 years, a 31% difference in the age group 41 - 60 years, and an 11% difference in the age group 61+ years. Peritoneal dialysis and HD resulted in similar frequencies of transplantation (50% and 41%, respectively) and expected survival (3.58 years and 3.56 years, respectively) during the first 5 years after the initiation of treatment. ? Conclusion: The cost-utility ratio is most favorable for PD as the primary method of treatment for patients eligible for both PD and HD.
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- Sennfält, Karin, et al.
(författare)
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Costs and effect of biennial prostate cancer screening in Sweden : results from a randomized trial in a defined population
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: The aim was to estimate the lifetime cost in relation to the extra number of detected localized and potentially curable cancers, and to estimate the economic impact on health care of repeated screening for prostate cancer in Sweden in a cohort of men aged 50-64 years.Material and Methods: From the total male population in the city of Gothenburg born between 1930-1944 (n=32,298), 10,000 men were randornized to prostate cancer screening beginning in January 1995, and 10,000 men were randomized to serve as a control group. PSA tests were offered every 2nd year until the age of 70. All health care costs for administration of the screening programme, screening tests, diagnostic procedures, and treatments were included. Data on detected cancers were collected from the prospective programme and from patient records. A Markov model was developed to calculate the cost-effectiveness and the total extra cost of the screening programme.Results: For the period from the start of the screening programme until death, the estimates were 17.7 extra localized cancers per 1,000 men and 7.3 extra cases of curative aimed treatments per 1,000 men. The incremental cost per extra detected localized cancer was calculated at 98,000 SEK, and per cancer with curative aimed treatment the figure was 236,000 SEK. Introducing this screening programme for prostate cancer in Sweden would yield 92 million SEK annually in additional costs for screening and management compared to a non-screening strategy.Conclusion: Introduction of prostate cancer screening with PSA would increase the total economic burden of prostate cancer for society by approximately 30 percent. Due to the lack of scientific data concerning possible survival benefits from prostate cancer screening, we must wait several years before the true cost-effectiveness of the programme can be calculated.
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