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.