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Portnoy A, Pedersen K, Kim JJ, Burger EA. Vaccination and screening strategies to accelerate cervical cancer elimination in Norway: a model-based analysis. Br J Cancer 2024:10.1038/s41416-024-02682-y. [PMID: 38643338 DOI: 10.1038/s41416-024-02682-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 03/31/2024] [Accepted: 04/03/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Experts have proposed an 'EVEN FASTER' concept targeting age-groups maintaining circulation of human papillomavirus (HPV). We explored effects of the vaccination component of these proposals compared with cervical cancer (CC) screening-based interventions on age-standardized incidence rate (ASR) and CC elimination (<4 cases/100,000) timing in Norway. METHODS We used a model-based approach to evaluate HPV vaccination and CC screening scenarios compared with a status-quo scenario reflecting previous vaccination and screening. For cohorts ages 25-30 years, we examined 6 vaccination scenarios that incrementally increased vaccination coverage from current cohort-specific rates. Each vaccination scenario was coupled with three screening strategies that varied screening frequency. Additionally, we included 4 scenarios that alternatively increased screening adherence. Population- and cohort-level outcomes included ASR, lifetime risk of CC, and colposcopy referrals. RESULTS Several vaccination strategies coupled with de-intensified screening frequencies lowered ASR, but did not accelerate CC elimination. Alternative strategies that increased screening adherence could both accelerate elimination and improve ASR. CONCLUSIONS The vaccination component of an 'EVEN FASTER' campaign is unlikely to accelerate CC elimination in Norway but may reduce population-level ASR. Alternatively, targeting under- and never-screeners may both eliminate CC faster and lead to greater health benefits compared with vaccination-based interventions we considered.
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Affiliation(s)
- Allison Portnoy
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Kine Pedersen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Jane J Kim
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Emily A Burger
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
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Henkel PS, Burger EA, Sletner L, Pedersen K. Exploring Structural Uncertainty in Cost-Effectiveness Modeling of Gestational Diabetes Screening: An Application Example from Norway. Med Decis Making 2024:272989X241241339. [PMID: 38591188 DOI: 10.1177/0272989x241241339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
BACKGROUND Screening pregnant women for gestational diabetes mellitus (GDM) has recently been expanded in Norway, although screening eligibility criteria continue to be debated. We aimed to compare the cost-effectiveness of alternative GDM screening strategies and explored structural uncertainty and the value of future research in determining the most cost-effective eligibility criteria for GDM screening in Norway. DESIGN We developed a probabilistic decision tree to estimate the total costs and health benefits (i.e., quality-adjusted life-years; QALYs) associated with 4 GDM screening strategies (universal, current guidelines, high-risk, and no screening). We identified the most cost-effective strategy as the strategy with the highest incremental cost-effectiveness ratio below a Norwegian benchmark for cost-effectiveness ($28,400/QALY). We excluded inconclusive evidence on the effects of screening on later maternal type 2 diabetes mellitus (T2DM) in the primary analysis but included this outcome in a secondary analysis using 2 different sources of evidence (i.e., Cochrane or US Preventive Services Task Force). To quantify decision uncertainty, we conducted scenario analysis and value-of-information analyses. RESULTS Current screening recommendations were considered inefficient in all analyses, while universal screening was most cost-effective in our primary analysis ($26,014/QALY gained) and remained most cost-effective when we assumed a preventive effect of GDM treatment on T2DM. When we assumed no preventive effect, high-risk screening was preferred ($19,115/QALY gained). When we assumed GDM screening does not prevent perinatal death in scenario analysis, all strategies except no screening exceeded the cost-effectiveness benchmark. In most analyses, decision uncertainty was high. CONCLUSIONS The most cost-effective screening strategy, ranging from no screening to universal screening, depended on the source and inclusion of GDM treatment effects on perinatal death and T2DM. Further research on these long-term outcomes could reduce decision uncertainty. HIGHLIGHTS This article analyses the cost-effectiveness of 4 alternative gestational diabetes mellitus (GDM) screening strategies in Norway: universal screening, current (broad) screening, high-risk screening, and no screening.The current Norwegian screening recommendations were considered inefficient under all analyses.The most cost-effective screening strategy ranged from no screening to universal screening depending on the source and inclusion of GDM treatment effects on later maternal diabetes and perinatal death.The parameters related to later maternal diabetes and perinatal death accounted for most of the decision uncertainty.
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Affiliation(s)
- Pia S Henkel
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Emily A Burger
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Line Sletner
- Department of Pediatric and Adolescents Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Kine Pedersen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
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Sten-Gahmberg S, Pedersen K, Harsheim IG, Loyland HI, Abelsen B. Correction: Experiences with telemedicine-based follow-up of chronic conditions: the views of patients and health personnel enrolled in a pragmatic randomized controlled trial. BMC Health Serv Res 2024; 24:441. [PMID: 38589852 PMCID: PMC11003127 DOI: 10.1186/s12913-024-10890-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Affiliation(s)
- Susanna Sten-Gahmberg
- , Oslo Economics, Klingenberggata 7, 0161, Oslo, Norway.
- The Finnish Centre for Pensions, FI-00065, Eläketurvakeskus, Finland.
| | - Kine Pedersen
- , Oslo Economics, Klingenberggata 7, 0161, Oslo, Norway
- Department of Health Management and Health Economics, University of Oslo, Postboks 1089, 0317, Blindern, Oslo, Norway
| | | | | | - Birgit Abelsen
- Department of Community Health, UiT - The Arctic University of Norway, 9037, Tromsø, Norway
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Portnoy A, Pedersen K, Sy S, Tropé A, Engesaeter B, Kim JJ, Burger EA. Cost-effectiveness of primary human papillomavirus triage approaches among vaccinated women in Norway: A model-based analysis. Int J Cancer 2024; 154:1073-1081. [PMID: 38088449 DOI: 10.1002/ijc.34804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/30/2023] [Accepted: 11/07/2023] [Indexed: 01/23/2024]
Abstract
As Norway considers revising triage approaches following their first adolescent cohort with human papillomavirus (HPV) vaccination entering the cervical cancer screening program, we analyzed the health impact and cost-effectiveness of alternative primary HPV triage approaches for women initiating cervical cancer screening in 2023. We used a multimodeling approach that captured HPV transmission and cervical carcinogenesis to evaluate the health benefits, harms and cost-effectiveness of alternative extended genotyping and age-based triage strategies under five-yearly primary HPV testing (including the status-quo screening strategy in Norway) for women born in 1998 (ie, age 25 in 2023). We examined 35 strategies that varied alternative groupings of high-risk HPV genotypes ("high-risk" genotypes; "medium-risk" genotypes or "intermediate-risk" genotypes), number and types of HPV included in each group, management of HPV-positive women to direct colposcopy or active surveillance, wait time for re-testing and age at which the HPV triage algorithm switched from less to more intensive strategies. Given the range of benchmarks for severity-specific cost-effectiveness thresholds in Norway, we found that the preferred strategy for vaccinated women aged 25 years in 2023 involved an age-based switch from a less to more intensive follow-up algorithm at age 30 or 35 years with HPV-16/18 genotypes in the "high-risk" group. The two potentially cost-effective strategies could reduce the number of colposcopies compared to current guidelines and simultaneously improve health benefits. Using age to guide primary HPV triage, paired with selective HPV genotype and follow-up time for re-testing, could improve both the cervical cancer program effectiveness and efficiency.
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Affiliation(s)
- Allison Portnoy
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kine Pedersen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Stephen Sy
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ameli Tropé
- Section for Cervical Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Birgit Engesaeter
- Section for Cervical Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Jane J Kim
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Emily A Burger
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
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Sten-Gahmberg S, Pedersen K, Harsheim IG, Løyland HI, Abelsen B. Experiences with telemedicine-based follow-up of chronic conditions: the views of patients and health personnel enrolled in a pragmatic randomized controlled trial. BMC Health Serv Res 2024; 24:341. [PMID: 38486179 PMCID: PMC10941467 DOI: 10.1186/s12913-024-10732-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 02/15/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Telemedicine is often promoted as a possible solution to some of the challenges healthcare systems in many countries face, and an increasing number of studies evaluate the clinical effects. So far, the studies show varying results. Less attention has been paid to systemic factors, such as the context, implementation, and mechanisms of these interventions. METHODS This study evaluates the experiences of patients and health personnel enrolled in a pragmatic randomized controlled trial comparing telemedicine-based follow-up of chronic conditions with usual care. Patients in the intervention group received an individual treatment plan together with computer tablets and home telemonitoring devices to report point-of-care measurements, e.g., blood pressure, blood glucose or oxygen saturation, and to respond to health related questions reported to a follow-up service. In response to abnormal measurement results, a follow-up service nurse would contact the patient and consider relevant actions. We conducted 49 interviews with patients and 77 interviews with health personnel and managers at the local centers. The interview data were analyzed using thematic analysis and based on recommendations for conducting process evaluation, considering three core aspects within the process of delivering a complex intervention: (1) context, (2) implementation, and (3) mechanisms of impact. RESULTS Patients were mainly satisfied with the telemedicine-based service, and experienced increased safety and understanding of their symptoms and illness. Implementation of the service does, however, require dedicated resources over time. Slow adjustment of other healthcare providers may have contributed to the absence of reductions in the use of specialized healthcare and general practitioner (GP) services. An evident advantage of the service is its flexibility, yet this may also challenge cost-efficiency of the intervention. CONCLUSIONS The implementation of a telemedicine-based service in primary healthcare is a complex process that is sensitive to contextual factors and that requires time and dedicated resources to ensure successful implementation. TRIAL REGISTRATION The trial was registered in www. CLINICALTRIALS gov (NCT04142710). Study start: 2019-02-09, Study completion: 2021-06-30, Study type: Interventional, Intervention/treatment: Telemedicine tablet and tools to perform measurements. Informed and documented consent was obtained from all subjects and next of kin participating in the study.
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Affiliation(s)
- Susanna Sten-Gahmberg
- Oslo Economics, Klingenberggata 7, Oslo, 0161, Norway.
- The Finnish Centre for Pensions, Eläketurvakeskus, FI-00065, Finland.
| | - Kine Pedersen
- Oslo Economics, Klingenberggata 7, Oslo, 0161, Norway
- Department of Health Management and Health Economics, University of Oslo, Postboks 1089, Blindern, Oslo, 0317, Norway
| | | | | | - Birgit Abelsen
- Department of Community Health, UiT - The Arctic University of Norway, Tromsø, 9037, Norway
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Pedersen K, van Schalkwyk J, Brewerton M, Jordan A, Cooke P. Penicillin cross-sensitivity in patients with confirmed peri-operative allergic hypersensitivity reactions to cefazolin: a retrospective observational study. Anaesthesia 2024; 79:208-210. [PMID: 37989486 DOI: 10.1111/anae.16185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 11/23/2023]
Affiliation(s)
- K Pedersen
- Te Toka Tumai Auckland, Auckland City Hospital, Auckland, New Zealand
| | - J van Schalkwyk
- Te Toka Tumai Auckland, Auckland City Hospital, Auckland, New Zealand
| | - M Brewerton
- Te Toka Tumai Auckland, Auckland City Hospital, Auckland, New Zealand
| | - A Jordan
- Te Toka Tumai Auckland, Auckland City Hospital, Auckland, New Zealand
| | - P Cooke
- Te Toka Tumai Auckland, Auckland City Hospital, Auckland, New Zealand
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Sten-Gahmberg S, Pedersen K, Harsheim IG, Løyland HI, Snilsberg Ø, Iversen T, Godager G, Sæther EM, Abelsen B. Pragmatic randomized controlled trial comparing a complex telemedicine-based intervention with usual care in patients with chronic conditions. Eur J Health Econ 2024:10.1007/s10198-023-01664-w. [PMID: 38291176 DOI: 10.1007/s10198-023-01664-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Abstract
This study evaluates a complex telemedicine-based intervention targeting patients with chronic health problems. Computer tablets and home telemonitoring devices are used by patients to report point-of-care measurements, e.g., blood pressure, blood glucose or oxygen saturation, and to answer health-related questions at a follow-up center. We designed a pragmatic randomized controlled trial to compare the telemedicine-based intervention with usual care in six local centers in Norway. The study outcomes included health-related quality of life (HRQoL) based on the EuroQol questionnaire (EQ-5D-5L), patient experiences, and utilization of healthcare. We also conducted a cost-benefit analysis to inform policy implementation, as well as a process evaluation (reported elsewhere). We used mixed methods to analyze data collected during the trial (health data, survey data and interviews with patients and health personnel) as well as data from national health registers. 735 patients were included during the period from February 2019 to June 2020. One year after inclusion, the effects on the use of healthcare services were mixed. The proportion of patients receiving home-based care services declined, but the number of GP contacts increased in the intervention group compared to the control group. Participants in the intervention group experienced improved HRQoL compared to the control group and were more satisfied with the follow-up of their health. The cost-benefit of the intervention depends largely on the design of the service and the value society places on improved safety and self-efficacy.
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Affiliation(s)
- Susanna Sten-Gahmberg
- Oslo Economics, Klingenberggata 7, 0161, Oslo, Norway.
- The Finnish Centre for Pensions, 00065, ELÄKETURVAKESKUS, Finland.
| | - Kine Pedersen
- Oslo Economics, Klingenberggata 7, 0161, Oslo, Norway
- Department of Health Management and Health Economics, University of Oslo, Postboks 1089 Blindern, 0317, Oslo, Norway
| | | | | | - Øyvind Snilsberg
- Department of Health Management and Health Economics, University of Oslo, Postboks 1089 Blindern, 0317, Oslo, Norway
| | - Tor Iversen
- Department of Health Management and Health Economics, University of Oslo, Postboks 1089 Blindern, 0317, Oslo, Norway
| | - Geir Godager
- Department of Health Management and Health Economics, University of Oslo, Postboks 1089 Blindern, 0317, Oslo, Norway
| | | | - Birgit Abelsen
- Norwegian Centre for Rural Medicine, Department of Community Medicine, UiT - The Arctic University of Norway, 9037, Tromsø, Norway
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Pedersen K, van Schalkwyk J, Brewerton M, Jordan A, Cooke P. Retrospective observational study of the incidence of peri-operative allergic hypersensitivity reactions to cefazolin. Anaesthesia 2023; 78:1502-1504. [PMID: 37451258 DOI: 10.1111/anae.16101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 07/18/2023]
Affiliation(s)
- K Pedersen
- Te Toka Tumai Auckland, Auckland City Hospital, Auckland, New Zealand
| | - J van Schalkwyk
- Te Toka Tumai Auckland, Auckland City Hospital, Auckland, New Zealand
| | - M Brewerton
- Te Toka Tumai Auckland, Auckland City Hospital, Auckland, New Zealand
| | - A Jordan
- Te Toka Tumai Auckland, Auckland City Hospital, Auckland, New Zealand
| | - P Cooke
- Te Toka Tumai Auckland, Auckland City Hospital, Auckland, New Zealand
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Pedersen K, Watt J, Maimone C, Hang H, Denys A, Schroder K, Suva LJ, Chen JR, Ronis MJJ. Deletion of NADPH oxidase 2 in chondrocytes exacerbates ethanol-mediated growth plate disruption in mice without major effects on bone architecture or gene expression. Alcohol Clin Exp Res (Hoboken) 2023; 47:2233-2247. [PMID: 38151780 DOI: 10.1111/acer.15203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Excess reactive oxygen species generated by NADPH oxidase 2 (Nox2) in response to ethanol exposure mediate aspects of skeletal toxicity including increased osteoclast differentiation and activity. Because perturbation of chondrocyte differentiation in the growth plate by ethanol could be prevented by dietary antioxidants, we hypothesized that Nox2 in the growth plate was involved in ethanol-associated reductions in longitudinal bone growth. METHODS Nox2 conditional knockout mice were generated, where the essential catalytic subunit of Nox2, cytochrome B-245 beta chain (Cybb), is deleted in chondrocytes using a Cre-Lox model with Cre expressed from the collagen 2a1 promoter (Col2a1-Cre). Wild-type and Cre-Lox mice were fed an ethanol Lieber-DeCarli-based diet or pair-fed a control diet for 8 weeks. RESULTS Ethanol treatment significantly reduced the number of proliferating chondrocytes in the growth plate, enhanced bone marrow adiposity, shortened femurs, reduced body length, reduced cortical bone volume, and decreased mRNA levels of a number of osteoblast and chondrocyte genes. Conditional knockout of Nox2 enzymatic activity in chondrocytes did not consistently prevent any ethanol effects. Rather, knockout mice had fewer proliferating chondrocytes than wild-type mice in both the ethanol- and control-fed animals. Additional analysis of tibia samples from Nox4 knockout mice showed that loss of Nox4 activity also reduced the number of proliferating chondrocytes and altered chondrocyte size in the growth plate. CONCLUSIONS Although Nox enzymatic activity regulates growth plate development, ethanol-associated disruption of the growth plate morphology is independent of ethanol-mediated increases in Nox2 activity.
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Affiliation(s)
- K Pedersen
- Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Science Center, New Orleans, Louisiana, USA
| | - J Watt
- Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Science Center, New Orleans, Louisiana, USA
| | - C Maimone
- Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Science Center, New Orleans, Louisiana, USA
| | - H Hang
- Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Science Center, New Orleans, Louisiana, USA
| | - A Denys
- Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Science Center, New Orleans, Louisiana, USA
| | - K Schroder
- Institute of Physiology I, Goethe-University, Frankfurt, Germany
| | - L J Suva
- Department of Veterinary Physiology and Pharmacology, Texas A&M University, College Station, Texas, USA
| | - J-R Chen
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - M J J Ronis
- Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Science Center, New Orleans, Louisiana, USA
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Abelsen B, Pedersen K, Løyland HI, Aandahl E. Expanding general practice with interprofessional teams: a mixed-methods patient perspective study. BMC Health Serv Res 2023; 23:1327. [PMID: 38037165 PMCID: PMC10691031 DOI: 10.1186/s12913-023-10322-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Across healthcare systems, current health policies promote interprofessional teamwork. Compared to single-profession general practitioner care, interprofessional primary healthcare teams are expected to possess added capacity to care for an increasingly complex patient population. This study aims to explore patients' experiences when their usual primary healthcare encounter with general practice shifts from single-profession general practitioner care to interprofessional team-based care. METHODS Qualitative and quantitative data were collected through interviews and a survey among Norwegian patients. The interviews included ten patients (five women and five men) aged between 28 and 89, and four next of kin (all women). The qualitative analysis was carried out using thematic analysis and a continuity framework. The survey included 287 respondents, comprising 58 per cent female and 42 per cent male participants, aged 18 years and above. The respondents exhibited multiple diagnoses and often a lengthy history of illness. All participants experienced the transition to interprofessional teamwork at their general practitioner surgery as part of a primary healthcare team pilot. RESULTS The interviewees described team-based care as more fitting and better coordinated, including more time and more learning than with single-profession general practitioner care. Most survey respondents experienced improvements in understanding and mastering their health problems. Multi-morbid elderly interviewees and interviewees with mental illness shared experiences of improved information continuity. They found that important concerns they had raised with the nurse were known to the general practitioner and vice versa. None of the interviewees expressed dissatisfaction with the inclusion of a nurse in their general practitioner relationship. Several interviewees noted improved access to care. The nurse was seen as a strengthening link to the general practitioner. The survey respondents expressed strong agreement with being followed up by a nurse. The interviewees trusted that it was their general practitioner who controlled what happened to them in the general practitioner surgery. CONCLUSION From the patients' perspective, interprofessional teamwork in general practice can strengthen management, informational, and relational continuity. However, a prerequisite seems to be a clear general practitioner presence in the team.
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Affiliation(s)
- Birgit Abelsen
- Department of Community Medicine, National Centre for Rural Medicine, UiT The Arctic University of Norway, Postbox 6050 Langnes, 9037, Tromsø, Norway.
| | - Kine Pedersen
- Oslo Economics, Klingenberggata 7, Oslo, 0161, Norway
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Pedersen K, Kristiansen IS, Sy S, Kim JJ, Burger EA. Designing Guidelines for Those Who Do Not Follow Them: The Impact of Adherence Assumptions on Optimal Screening Guidelines. Value Health 2023:S1098-3015(23)02562-7. [PMID: 37116697 DOI: 10.1016/j.jval.2023.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/05/2023] [Accepted: 04/15/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVES Model-based cost-effectiveness analyses can inform decisions about screening guidelines by quantifying consequences of alternative algorithms. Although actual screening adherence is imperfect, incorporating nonadherence into analyses that aim to determine optimal screening may affect the policy recommendations. We evaluated the impact of nonadherence assumptions on the optimal cervical cancer screening in Norway. METHODS We used a microsimulation model of cervical carcinogenesis to project the long-term health and economic outcomes under alternative screening algorithms and adherence patterns. We compared 18 algorithms involving primary human papillomavirus testing (5-yearly) that varied follow-up management of different human papillomavirus results. We considered 12 adherence scenarios: perfect adherence, 8 high- and low-coverage "random-complier" scenarios, and 3 "systematic-complier" scenarios that reflect conditional screening behavior over a lifetime. We calculated incremental cost-effectiveness ratios and considered a strategy with the highest incremental cost-effectiveness ratio < 55 000 US dollars/quality-adjusted life-year as "optimal." RESULTS Under perfect adherence, the least intensive screening strategy was optimal; in contrast, assuming any nonadherence resulted in a more intensive optimal strategy. Accounting for lower adherence resulted in both lower costs and health benefits, which allowed for a more intensive strategy to be considered optimal, but more harms for women who screen according to guidelines (ie, up to 41% more colposcopies when comparing the optimal strategy in the lowest-adherence scenario with the optimal strategy under perfect adherence). CONCLUSIONS Assuming nonadherence in analyses designed to inform national guidelines may lead to a relatively more intensive recommendation. Designing guidelines for those who do not adhere to them may lead to over-screening of those who do.
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Affiliation(s)
- Kine Pedersen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
| | - Ivar S Kristiansen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway; Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Stephen Sy
- Department of Health Policy and Management and Center for Health Decision Science, Harvard T.H. Chan School of Public Health, United States, Boston, MA, USA
| | - Jane J Kim
- Department of Health Policy and Management and Center for Health Decision Science, Harvard T.H. Chan School of Public Health, United States, Boston, MA, USA
| | - Emily A Burger
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway; Department of Health Policy and Management and Center for Health Decision Science, Harvard T.H. Chan School of Public Health, United States, Boston, MA, USA
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Knauss T, Hansen BT, Pedersen K, Aasbø G, Kunst N, Burger EA. The cost-effectiveness of opt-in and send-to-all HPV self-sampling among long-term non-attenders to cervical cancer screening in Norway: The Equalscreen randomized controlled trial. Gynecol Oncol 2023; 168:39-47. [PMID: 36371904 DOI: 10.1016/j.ygyno.2022.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/12/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We assessed the cost-effectiveness of mailing a human papillomavirus self-sampling (HPV-ss) kit, directly or via invitation to order, compared with mailing reminder letters among long-term non-attenders in Norway. METHODS We conducted a secondary analysis using the Equalscreen study data with 6000 women aged 35-69 years who had not screened in 10+ years. Participants were equally randomized into three arms: reminder letter (control); invitation to order HPV-ss kit (opt-in); directly mailed HPV-ss kit (send-to-all). Cost-effectiveness (2020 Great British Pounds (GBP)) was estimated using incremental cost-effectiveness ratios (ICERs) per additional screened woman, and per additional cervical intraepithelial neoplasia grade 2 or worse (CIN2+) from extended and direct healthcare perspectives. RESULTS Participation, CIN2+ detection, and total screening costs were highest in the send-to-all arm, followed by the opt-in and control arms. Non-histological physician appointments contributed to 67% of the total costs in the control arm and ≤ 31% in the self-sampling arms. From an expanded healthcare perspective, the ICERs were 135 GBP and 169 GBP per additional screened woman, and 2864 GBP and 4165 GBP per additional CIN2+ detected for the opt-in and send-to-all, respectively. CONCLUSIONS Opt-in and send-to-all self-sampling were more effective and, depending on willingness-to-pay, may be considered cost-effective alternatives to improve screening attendance in Norway.
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Affiliation(s)
- Tara Knauss
- Department of Health Management and Health Economics, University of Oslo, Postboks 1089 Blindern, 0317 Oslo, Norway
| | - Bo T Hansen
- Department of Research, Cancer Registry of Norway, P.O. box 5313 Majorstuen, NO-0304 Oslo, Norway; Department of Infection Control and Vaccine, Norwegian Institute of Public Health, PO Box 222 Skøyen, 0213 Oslo, Norway
| | - Kine Pedersen
- Department of Health Management and Health Economics, University of Oslo, Postboks 1089 Blindern, 0317 Oslo, Norway
| | - Gunvor Aasbø
- Department of Research, Cancer Registry of Norway, P.O. box 5313 Majorstuen, NO-0304 Oslo, Norway; Department of Interdisciplinary Health Science, Institute of Health and Society, University of Oslo, Postboks 1089 Blindern, 0317 Oslo, Norway
| | - Natalia Kunst
- Department of Health Management and Health Economics, University of Oslo, Postboks 1089 Blindern, 0317 Oslo, Norway; Public Health Modeling Unit, Yale University School of Public Health, P.O. Box 208034, 60 College Street, New Haven, CT 06520-0834, USA; Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale University School of Medicine, Harkness Office Building, 367 Cedar Street, New Haven, CT 06520-8023, USA
| | - Emily A Burger
- Department of Health Management and Health Economics, University of Oslo, Postboks 1089 Blindern, 0317 Oslo, Norway; Harvard Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave, Boston, MA, USA.
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Waters M, Inkman M, Kang L, Denardo D, Henke L, Badiyan S, Smith R, Glasgow S, Grierson P, Pedersen K, Zhang J, Kim H. Convolutional Neural Network Classification of Pretreatment Biopsies of Rectal Adenocarcinoma Predicts Complete Clinical Response to Short-Course Radiation and Consolidation Chemotherapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Hurri E, Ohlson A, Lundberg Å, Aspán A, Pedersen K, Tråvén M. Herd-level prevalence of Mycoplasma bovis in Swedish dairy herds determined by antibody ELISA and PCR on bulk tank milk and herd characteristics associated with seropositivity. J Dairy Sci 2022; 105:7764-7772. [PMID: 35879164 DOI: 10.3168/jds.2021-21390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 04/27/2022] [Indexed: 11/19/2022]
Abstract
Mycoplasma bovis is an important pathogen causing pneumonia, mastitis, and arthritis in cattle, leading to reduced animal welfare and economic losses worldwide. In this cross-sectional study, we investigated the prevalence of M. bovis in bulk tank milk (BTM) and herd characteristics associated with a positive antibody test result in Swedish dairy herds. Bulk tank milk samples from all Swedish dairy herds (n = 3,144) were collected and analyzed with ID Screen antibody ELISA and PCR. Information on herd characteristics was collected from the national Dairy Herd Improvement database. To identify herd characteristics associated with the presence of antibodies in BTM, logistic regression was used in 4 different models. The apparent herd-level prevalence of M. bovis infection based on antibodies in BTM was 4.8%, with large regional differences ranging from 0 to 20%. None of the BTM samples was positive by PCR. All the antibody-positive herds were situated in the south of Sweden. The logistic regression model showed that larger herds had higher odds of detectable antibodies in BTM (herd size >120 cows, odds ratio = 8.8). An association was also found between antibodies in BTM and both a higher late calf mortality (2-6 mo) and a higher young stock mortality (6-15 mo). This study showed a clear regional difference in the apparent prevalence of M. bovis infection based on antibodies. The relatively low prevalence of M. bovis in Sweden is a strong motivator for the cattle industry to take steps to prevent further spread of the infection. It is essential that the M. bovis status of free herds be known, and the regional differences shown in this study suggest that testing is highly recommended when live cattle from high-prevalence areas are being introduced into herds. We do not recommend using PCR on BTM to detect infected herds, owing to the low detection frequency in this study.
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Affiliation(s)
- E Hurri
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, SE-750 07 Uppsala, Sweden; Department of Animal Health and Antimicrobial Strategies, National Veterinary Institute (SVA), SE-751 89 Uppsala, Sweden.
| | - A Ohlson
- Section of Animal Health, Växa Sverige, SE-101 24 Stockholm, Sweden
| | - Å Lundberg
- Section of Animal Health, Växa Sverige, SE-101 24 Stockholm, Sweden
| | - A Aspán
- Department of Animal Health and Antimicrobial Strategies, National Veterinary Institute (SVA), SE-751 89 Uppsala, Sweden
| | - K Pedersen
- Department of Animal Health and Antimicrobial Strategies, National Veterinary Institute (SVA), SE-751 89 Uppsala, Sweden
| | - M Tråvén
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, SE-750 07 Uppsala, Sweden
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Portnoy A, Pedersen K, Nygård M, Trogstad L, Kim JJ, Burger EA. Identifying a Single Optimal Integrated Cervical Cancer Prevention Policy in Norway: A Cost-Effectiveness Analysis. Med Decis Making 2022; 42:795-807. [PMID: 35255741 DOI: 10.1177/0272989x221082683] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Interventions targeting the same disease but at different points along the disease continuum (e.g., screening and vaccination to prevent cervical cancer [CC]) are often evaluated in isolation, which can affect cost-effectiveness profiles and policy conclusions. We evaluated nonavalent human papillomavirus (HPV) vaccine (9vHPV) compared with bivalent HPV vaccine (2vHPV) alongside deintensified screening intervals for a vaccinated birth cohort to inform a single optimal integrated CC prevention policy. METHODS Using a multimodeling approach, we evaluated the health and economic impacts of alternative CC screening strategies for a Norwegian birth cohort eligible for HPV vaccination in 2021 assuming they received 1) 2vHPV or 2) 9vHPV. We conducted 1) a restricted analysis that evaluated the optimal HPV vaccine under current screening guidelines; and 2) a comprehensive analysis including alternative screening and vaccination strategy combinations. We calculated incremental cost-effectiveness ratios (ICERs) and evaluated them according to different cost-effectiveness thresholds. RESULTS Assuming a cost-effectiveness threshold of $40,000 per quality-adjusted life year (QALY) gained, we found that, while holding screening intensity fixed, switching the routine vaccination program in Norway from 2vHPV to 9vHPV would not be considered cost-effective (ICER of $132,700 per QALY gained). However, when allowing for varying intensities of CC screening, we found that switching to 9vHPV would be cost-effective compared with 2vHPV under an alternative threshold of $55,000 per QALY gained, if coupled with reductions in the number of lifetime screens. CONCLUSIONS Our analysis highlights the importance of evaluating the full potential policy landscape for country-level decision makers considering policy adoption, including nonindependent primary and secondary prevention efforts, to draw appropriate conclusions and avoid sub-optimal outcomes. HIGHLIGHTS Without evaluating the full potential policy landscape, including primary and secondary prevention efforts, country-level decision makers may not be able to draw appropriate policy conclusions, resulting in suboptimal outcomes.An applied example from cervical cancer prevention in Norway compared a restricted analysis of current screening guidelines to a comprehensive analysis including alternative screening and vaccination strategy combinations.We found that a switch from bivalent to nonavalent human papillomavirus vaccine would be considered cost-effective in Norway if coupled with reductions in the number of lifetime screens compared with the current screening strategy.A comprehensive analysis that considers how different types of interventions along the disease continuum affect each other will be critical for decision makers interpreting cost-effectiveness analysis results.
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Affiliation(s)
- Allison Portnoy
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kine Pedersen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Lill Trogstad
- The Norwegian Institute of Public Health, Oslo, Norway
| | - Jane J Kim
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Emily A Burger
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
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Pedersen K, Portnoy A, Sy S, Hansen BT, Tropé A, Kim JJ, Burger EA. Switching clinic-based cervical cancer screening programs to human papillomavirus self-sampling: A cost-effectiveness analysis of vaccinated and unvaccinated Norwegian women. Int J Cancer 2022; 150:491-501. [PMID: 34664271 DOI: 10.1002/ijc.33850] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 08/30/2021] [Accepted: 09/28/2021] [Indexed: 11/07/2022]
Abstract
Several countries have implemented primary human papillomavirus (HPV) testing for cervical cancer screening. HPV testing enables home-based, self-collected sampling (self-sampling), which provides similar diagnostic accuracy as clinician-collected samples. We evaluated the impact and cost-effectiveness of switching an entire organized screening program to primary HPV self-sampling among cohorts of HPV vaccinated and unvaccinated Norwegian women. We conducted a model-based analysis to project long-term health and economic outcomes for birth cohorts with different HPV vaccine exposure, that is, preadolescent vaccination (2000- and 2008-cohorts), multiage cohort vaccination (1991-cohort) or no vaccination (1985-cohort). We compared the cost-effectiveness of switching current guidelines with clinician-collected HPV testing to HPV self-sampling for these cohorts and considered an additional 44 strategies involving either HPV self-sampling or clinician-collected HPV testing at different screening frequencies for the 2000- and 2008-cohorts. Given Norwegian benchmarks for cost-effectiveness, we considered a strategy with an additional cost per quality-adjusted life-year below $55 000 as cost-effective. HPV self-sampling strategies considerably reduced screening costs (ie, by 24%-40% across cohorts and alternative strategies) and were more cost-effective than clinician-collected HPV testing. For cohorts offered preadolescent vaccination, cost-effective strategies involved HPV self-sampling three times (2000-cohort) and twice (2008-cohort) per lifetime. In conclusion, we found that switching from clinician-collected to self-collected HPV testing in cervical screening may be cost-effective among both highly vaccinated and unvaccinated cohorts of Norwegian women.
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Affiliation(s)
- Kine Pedersen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Allison Portnoy
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Stephen Sy
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | | | - Jane J Kim
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Emily A Burger
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Portnoy A, Pedersen K, Trogstad L, Hansen BT, Feiring B, Laake I, Smith MA, Sy S, Nygård M, Kim JJ, Burger EA. Cost-effectiveness of nonavalent HPV vaccine in Norway considering current empirical data and validation. Prev Med 2021; 150:106688. [PMID: 34303489 DOI: 10.1016/j.ypmed.2021.106688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/12/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Allison Portnoy
- Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA.
| | - Kine Pedersen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Lill Trogstad
- The Norwegian Institute of Public Health, Oslo, Norway
| | | | - Berit Feiring
- The Norwegian Institute of Public Health, Oslo, Norway
| | - Ida Laake
- The Norwegian Institute of Public Health, Oslo, Norway
| | - Megan A Smith
- Daffodil Centre, The University of Sydney, A Joint Venture With Cancer Council NSW, Sydney, Australia
| | - Stephen Sy
- Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA
| | | | - Jane J Kim
- Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA
| | - Emily A Burger
- Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA; Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
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Hassanzadeh C, Fallahian F, Low G, Roy A, Chin R, Pedersen K, Mutch M, Glasgow S, Henke L, Badiyan S, Kim H. PO-1249 Lateral Pelvic Nodal Boost During Short Course Radiation Therapy for Locally Advanced Rectal Cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07700-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Raghav K, Yoshino T, Taniguchi H, Tejpar S, Vogel A, Wainberg Z, Yamaguchi K, Fakih M, Pedersen K, Bando K, Kawakami H, Beck J, Kanai M, Liu Y, Mekan S, Pudussery G, Qiu Y, Kopetz S. P-45 An open-label, phase 2 study of patritumab deruxtecan in patients with previously treated advanced/metastatic colorectal cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Cyr PR, Pedersen K, Iyer AL, Bundorf MK, Goldhaber-Fiebert JD, Gyrd-Hansen D, Kristiansen IS, Burger EA. Providing more balanced information on the harms and benefits of cervical cancer screening: A randomized survey among US and Norwegian women. Prev Med Rep 2021; 23:101452. [PMID: 34221852 PMCID: PMC8242055 DOI: 10.1016/j.pmedr.2021.101452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 11/26/2022] Open
Abstract
Additional information did not impact intentions to participate in CC screening. Additional information increased uncertainty to seek precancer treatment in Norway. Women reported strong system-specific preferences for sources of information. Having a prior Pap-test was an important predictor of intentions-to-participate. Socioeconomic factors influenced follow-up intentions in the U.S. but not in Norway.
We aimed to identify how additional information about benefits and harms of cervical cancer (CC) screening impacted intention to participate in screening, what type of information on harms women preferred receiving, from whom, and whether it differed between two national healthcare settings. We conducted a survey that randomized screen-eligible women in the United States (n = 1084) and Norway (n = 1060) into four groups according to the timing of introducing additional information. We found that additional information did not significantly impact stated intentions-to-participate in screening or follow-up testing in either country; however, the proportion of Norwegian women stating uncertainty about seeking precancer treatment increased from 7.9% to 14.3% (p = 0.012). Women reported strong system-specific preferences for sources of information: Norwegians (59%) preferred it come from a national public health agency while Americans (59%) preferred it come from a specialist care provider. Regression models revealed having a prior Pap-test was the most important predictor of intentions-to-participate in both countries, while having lower income reduced the probabilities of intentions-to-follow-up and seek precancer treatment among U.S. women. These results suggest that additional information on harms is unlikely to reduce participation in CC screening but could increase decision uncertainty to seek treatment. Providing unbiased information would improve on the ethical principle of respect for autonomy and self-determination. However, the clinical impact of additional information on women’s understanding of the trade-offs involved with CC screening should be investigated. Future studies should also consider country-specific socioeconomic barriers to screening if communication re-design initiatives aim to improve CC screening participation.
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Affiliation(s)
- P R Cyr
- Department of Global Health and Community Medicine, Institute of Health and Society, University of Oslo, P.O. Box 1039 Blindern, 0318 Oslo, Norway
| | - K Pedersen
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P.O. Box 1039 Blindern, 0318 Oslo, Norway
| | - A L Iyer
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P.O. Box 1039 Blindern, 0318 Oslo, Norway
| | - M K Bundorf
- Stanford School of Public Policy, Duke University, Durham, NC 27708 and NBER, United States
| | - J D Goldhaber-Fiebert
- Centers for Health Policy and Primary Care and Outcomes Research, Stanford Health Policy, Stanford University, Stanford, CA, United States
| | - D Gyrd-Hansen
- Danish Centre for Health Economic, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9B, 1 Floor, 5000, Odense C, Denmark
| | - I S Kristiansen
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P.O. Box 1039 Blindern, 0318 Oslo, Norway
| | - E A Burger
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P.O. Box 1039 Blindern, 0318 Oslo, Norway
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Portnoy A, Pedersen K, Trogstad L, Hansen BT, Feiring B, Laake I, Smith MA, Sy S, Nygård M, Kim JJ, Burger EA. Impact and cost-effectiveness of strategies to accelerate cervical cancer elimination: A model-based analysis. Prev Med 2021; 144:106276. [PMID: 33678239 DOI: 10.1016/j.ypmed.2020.106276] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/28/2020] [Accepted: 09/27/2020] [Indexed: 12/12/2022]
Abstract
Following the global call for action by the World Health Organization to eliminate cervical cancer (CC), we evaluated how each CC policy decision in Norway influenced the timing of CC elimination, and whether introducing nonavalent human papillomavirus (HPV) vaccine would accelerate elimination timing and be cost-effective. We used a multi-modeling approach that captured HPV transmission and cervical carcinogenesis to estimate the CC incidence associated with six past and future CC prevention policy decisions compared with a pre-vaccination scenario involving 3-yearly cytology-based screening. Scenarios examined the introduction of routine HPV vaccination of 12-year-old girls with quadrivalent vaccine in 2009, a temporary catch-up program for females aged up to 26 years in 2016-2018 with bivalent vaccine, the universal switch to bivalent vaccine in 2017, expansion to include 12-year-old boys in 2018, the switch from cytology- to HPV-based screening for women aged 34-69 in 2020, and the potential switch to nonavalent vaccine in 2021. Introducing routine female vaccination in 2009 enabled elimination to be achieved by 2056 and prevented 17,300 cases. Cumulatively, subsequent policy decisions accelerated elimination to 2039. According to our modeling assumptions, switching to the nonavalent vaccine would not be considered 'good value for money' at relevant cost-effectiveness thresholds in Norway unless the incremental cost was $19 per dose or less (range: $17-24) compared to the bivalent vaccine. CC control policies implemented over the last decade in Norway may have accelerated the timeframe to elimination by more than 17 years and prevented over 23,800 cases by 2110.
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Affiliation(s)
- Allison Portnoy
- Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA.
| | - Kine Pedersen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Lill Trogstad
- The Norwegian Institute of Public Health, Oslo, Norway
| | | | - Berit Feiring
- The Norwegian Institute of Public Health, Oslo, Norway
| | - Ida Laake
- The Norwegian Institute of Public Health, Oslo, Norway
| | - Megan A Smith
- Cancer Council New South Wales, Sydney, Australia; Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Stephen Sy
- Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA
| | | | - Jane J Kim
- Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA
| | - Emily A Burger
- Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA; Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
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Chin R, Roy A, Pedersen K, Hunt S, Mutch M, Glasgow S, Silviera M, Wise P, Smith R, Wang-Gillam A, Tan B, Lim K, Suresh R, Amin M, Roach M, Badiyan S, Henke L, Kim H. Complete Clinical Response after Short-course Radiation and Sequential Multi-agent Chemotherapy for Non-operative Treatment of Rectal Adenocarcinoma. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kristensen CS, Christiansen MG, Pedersen K, Larsen LE. Production losses five months after outbreak with a recombinant of two PRRSV vaccine strains in 13 Danish sow herds. Porcine Health Manag 2020; 6:26. [PMID: 33042567 PMCID: PMC7537099 DOI: 10.1186/s40813-020-00165-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background In July 2019, a PRRSV-negative boar station was infected with a recombinant of two PRRSV vaccine strains, which subsequently spread to at least 36 herds that had received semen from the boar station. In the following months, all the infected herds reported reduced productivity. The aim of the present study was to evaluate the impact of the PRRS outbreak. Results Production data were collected from 13 of the herds. The average levels of farrowings/week, liveborns/litter, stillborns/litter, pre-weaning mortality and weaned pigs/litter were compared for the five-month period after infection and the preceding 7 months before infection with the new variant of PRRSV-1. Twelve herds experienced a decrease in farrowings/week (0.1-10.8% fewer farrowings/week), and all herds experienced fewer liveborns (0.8-4.8 fewer liveborns/litter) and more stillborns (0.6-2.6 more stillborns/litter). Pre-weaning mortality nearly doubled in half of the herds. Overall, the 13 herds were missing 2.4-6.5 pigs/litter at weaning during the 5 months after infection compared to the seven preceding months before infection. Conclusion In this study, the impact of this new PRRSV-1 variant on productivity exceeded that typically seen in Danish herds infected with PRRSV-1.
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Affiliation(s)
| | | | - K Pedersen
- SEGES Danish Pig Research Centre, Copenhagen, Denmark
| | - L E Larsen
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
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Fogelberg S, Clements MS, Pedersen K, Sy S, Sparén P, Kim JJ, Burger EA. Cost-effectiveness of cervical cancer screening with primary HPV testing for unvaccinated women in Sweden. PLoS One 2020; 15:e0239611. [PMID: 32997696 PMCID: PMC7526933 DOI: 10.1371/journal.pone.0239611] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/09/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Sweden revised their cervical cancer screening program in 2017 to include cytology-based screening for women aged 23-29 years and primary human papillomavirus (HPV) testing for women aged 30-64 years; however, alternative strategies may be preferred. To inform cervical cancer prevention policies for unvaccinated women, we evaluated the cost-effectiveness of alternative screening strategies, including the current Swedish guidelines. METHODS We adapted a mathematical simulation model of HPV and cervical cancer to the Swedish context using primary epidemiologic data. We compared the cost-effectiveness of alternative screening strategies that varied by the age to start screening, the age to switch from cytology to HPV testing, HPV strategies not preceded by cytology, screening frequency, and management of HPV-positive/cytology-negative women. RESULTS We found that the current Swedish guidelines were more costly and less effective than alternative primary HPV-based strategies. All cost-efficient strategies involved primary HPV testing not preceded by cytology for younger women. Given a cost-effectiveness threshold of €85,619 per quality-adjusted life year gained, the optimal strategy involved 5-yearly primary HPV-based screening for women aged 23-50 years and 10-yearly HPV-based screening for women older than age 50 years. CONCLUSIONS Primary screening based on HPV alone may be considered for unvaccinated women for those countries with similar HPV burdens.
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Affiliation(s)
- Sara Fogelberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mark S. Clements
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kine Pedersen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Stephen Sy
- Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jane J. Kim
- Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Emily A. Burger
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
- Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Park H, Sanjeevaiah A, Suresh R, Mehta R, Trikalinos N, Bagegni N, Aranha O, Pedersen K, Nixon A, Jin R, Mills J, Fields R, Amin M, Lim K, Tan B, Grierson P, Jiang S, Rosario MD, Wang-Gillam A, Lockhart A. P-131 Ramucirumab and irinotecan in patients with previously treated gastroesophageal adenocarcinoma: Interim analysis of a phase II trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Holmer I, Salomonsen CM, Jorsal SE, Astrup LB, Jensen VF, Høg BB, Pedersen K. Antibiotic resistance in porcine pathogenic bacteria and relation to antibiotic usage. BMC Vet Res 2019; 15:449. [PMID: 31829171 PMCID: PMC6907208 DOI: 10.1186/s12917-019-2162-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 10/29/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Optimal treatment and prudent use of antimicrobials for pigs is imperative to secure animal health and prevent development of critical resistance. An important step in this one-health context is to monitor resistance patterns of important animal pathogens. The aim of this study was to investigate the antimicrobial resistance patterns of five major pathogens in Danish pigs during a period from 2004 to 2017 and elucidate any developments or associations between resistance and usage of antibiotics. RESULTS The minimum inhibitory concentration (MIC) for Escherichia coli, Actinobacillus pleuropneumoniae, Streptococcus suis, Bordetella bronchiseptica, and Staphylococcus hyicus was determined to representatives of antibiotic classes relevant for treatment or surveillance. Escherichia coli isolates were mostly sensitive to fluoroquinolones and colistin, whereas high levels of resistance were observed to ampicillin, spectinomycin, streptomycin, sulfonamides and tetracycline. While resistance levels to most compounds remained relatively stable during the period, resistance to florfenicol increased from 2.1% in 2004 to 18.1% in 2017, likely in response to a concurrent increase in usage. A temporal association between resistance and usage was also observed for neomycin. E. coli serovars O138 and O149 were generally more resistant than O139. For A. pleuropneumoniae, the resistance pattern was homogenous and predictable throughout the study period, displaying high MIC values only to erythromycin whereas almost all isolates were susceptible to all other compounds. Most S. suis isolates were sensitive to penicillin whereas high resistance levels to erythromycin and tetracycline were recorded, and resistance to erythromycin and trimethoprim increasing over time. For S. hyicus, sensitivity to the majority of the antimicrobials tested was observed. However, penicillin resistance was recorded in 69.4-88.9% of the isolates. All B. bronchiseptica isolates were resistant to ampicillin, whereas all but two isolates were sensitive to florfenicol. The data obtained have served as background for a recent formulation of evidence-based treatment guidelines for pigs. CONCLUSIONS Antibiotic resistance varied for some pathogens over time and in response to usage. Resistance to critically important compounds was low. The results emphasize the need for continuous surveillance of resistance patterns also in pig pathogenic bacteria.
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Affiliation(s)
- I Holmer
- Technical University of Denmark, Kemitorvet Building 202, Anker Engelunds Vej 1, DK-2800, Kgs. Lyngby, Denmark
| | | | - S E Jorsal
- Technical University of Denmark, Kemitorvet Building 202, Anker Engelunds Vej 1, DK-2800, Kgs. Lyngby, Denmark
| | - L B Astrup
- Technical University of Denmark, Kemitorvet Building 202, Anker Engelunds Vej 1, DK-2800, Kgs. Lyngby, Denmark
| | - V F Jensen
- Technical University of Denmark, Kemitorvet Building 202, Anker Engelunds Vej 1, DK-2800, Kgs. Lyngby, Denmark
| | - B Borck Høg
- Technical University of Denmark, Kemitorvet Building 202, Anker Engelunds Vej 1, DK-2800, Kgs. Lyngby, Denmark
| | - K Pedersen
- National Veterinary Institute, Ulls väg 2B, 751 89, Uppsala, Sweden.
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Hylin H, Thrane H, Pedersen K, Kristiansen IS, Burger EA. The healthcare costs of treating human papillomavirus-related cancers in Norway. BMC Cancer 2019; 19:426. [PMID: 31064346 PMCID: PMC6505196 DOI: 10.1186/s12885-019-5596-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/10/2019] [Indexed: 12/24/2022] Open
Abstract
Background Public health efforts to prevent human papillomavirus (HPV)-related cancers include HPV vaccination and cervical cancer screening. We quantified the annual healthcare cost of six HPV-related cancers in order to provide inputs in cost-effectiveness analyses and quantify the potential economic savings from prevention of HPV-related cancers in Norway. Methods Using individual patient-level data from three unlinked population-based registries, we estimated the mean healthcare costs 1) annually across all phases of disease, 2) during the first 3 years of care following diagnosis, and 3) for the last 12 months of life for patients diagnosed with an HPV-related cancer. We included episodes of care related to primary care physicians, specialist care (private specialists and hospital-based care and prescriptions), and prescription drugs redeemed at pharmacies outside hospitals between 2012 and 2014. We valued costs (2014 €1.00 = NOK 8.357) based on diagnosis-related groups (DRG), patient copayments, reimbursement fees and pharmacy retail prices. Results In 2014, the total healthcare cost of HPV-related cancers amounted to €39.8 million, of which specialist care accounted for more than 99% of the total cost. The annual maximum economic burden potentially averted due to HPV vaccination will be lower for vulvar, penile and vaginal cancer (i.e., €984,620, €762,964 and €374,857, respectively) than for cervical, anal and oropharyngeal cancers (i.e., €17.2 million, €6.7 million and €4.6 million, respectively). Over the first three years of treatment following cancer diagnosis, patients diagnosed with oropharyngeal cancer incurred the highest total cost per patient (i.e. €49,774), while penile cancer had the lowest total cost per patient (i.e. €18,350). In general, costs were highest the first year following diagnosis and then declined; however, costs increased rapidly again towards end of life for patients who did not survive. Conclusion HPV-related cancers constitute a considerable economic burden to the Norwegian healthcare system. As the proportion of HPV-vaccinated individuals increase and secondary prevention approaches advance, this study highlights the potential economic burden avoided by preventing these cancers. Electronic supplementary material The online version of this article (10.1186/s12885-019-5596-2) contains supplementary material, which is available to authorized users.
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Srivastava A, Gabani P, Kim E, Lee H, Pedersen K, Kim H. Radiation and Medical Oncology Trainee Perceptions of the Prior Authorization Process: A National Survey. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Pedersen K, Foster N, Overman M, Boland P, Kim S, Arrambide K, Jaszewski B, Welch J, Wilson R, McWilliams R. ZEBRA: an ACCRU/IRCI multicenter phase 2 study of pembrolizumab in patients with advanced small bowel adenocarcinoma (SBA). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz154.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mahmmod YS, Svennesen L, Katholm J, Pedersen K, Klaas IC. Bayesian estimation of qPCR and bacterial culture accuracy for detection of bovine coagulase-negative staphylococci from milk and teat apex at different test cut-off points. J Appl Microbiol 2019; 127:406-417. [PMID: 31077513 DOI: 10.1111/jam.14309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/20/2019] [Accepted: 05/06/2019] [Indexed: 12/01/2022]
Abstract
AIM To primarily estimate the sensitivity (Se) and specificity (Sp) of the commercially available Mastit4 quantitative PCR (qPCR) assay and bacterial culture (BC) for diagnosis of intramammary infections (IMI) and teat apex colonization (TAC) with coagulase-negative staphylococci (CNS) at different cut-offs for qPCR cycle threshold values using Bayesian latent class analysis. A secondary objective was to evaluate two cut-offs of BC for diagnosis of IMI and TAC with CNS. METHODS AND RESULTS We randomly selected 13-20 cows with subclinical mastitis from eight dairy herds. Teat skin samples and aseptically collected foremilk samples were collected from the right hindquarters (n = 149) for BC and qPCR analysis. The Se of qPCR was always higher than BCSe in diagnosis of IMI, however; the Sp of BC was higher than qPCRSp . BCSe and BCSp showed no substantial difference between the tested BC cut-offs. In contrast to IMI, estimates of BC and qPCR in diagnosing TAC were different. BCSe was higher than qPCRSe at all tested cut-offs, however; qPCRSp was higher than BCSp . CONCLUSION The overall performance of qPCR is higher than BC in the diagnosis of IMI; however, the performance of BC is better than qPCR in diagnosis of TAC. The qPCR and BC are valid diagnostics for bovine IMI with CNS. However, for TAC, both techniques require further investigation to reduce the uncertainty of the true status of the quarter and teat skin. SIGNIFICANCE AND IMPACT OF THE STUDY We reported, for the first time, the diagnostic performance of new mastitis technology (Mastit4 PCR) and culture for detection of CNS in milk and nonmilk samples in dairy herds with automatic milking systems. Our findings will improve the interpretation of the test results of culture and qPCR assay and subsequently, will strengthen the control of IMI with CNS in dairy cows.
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Affiliation(s)
- Y S Mahmmod
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg C, Denmark.,Infectious Diseases, Department of Animal Medicine, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Sharkia Province, Egypt
| | - L Svennesen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - J Katholm
- DNA Diagnostic A/S, Risskov, Denmark
| | - K Pedersen
- National Veterinary Institute, Technical University of Denmark, Kongens Lyngby, Denmark
| | - I C Klaas
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg C, Denmark
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Ulriksen HU, Søndergaard T, Pedersen TG, Pedersen K. Plasmon enhanced light scattering into semiconductors by aperiodic metal nanowire arrays. Opt Express 2019; 27:14308-14320. [PMID: 31163881 DOI: 10.1364/oe.27.014308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/11/2019] [Indexed: 06/09/2023]
Abstract
Light scattering from nanostructures is an essential ingredient in several optical technologies, and experimental verification of simulations of light scattering is important. In particular, solar cells may benefit from light-trapping due to scattering. However, light that is successfully trapped in an absorbing media such as e.g. Si necessarily escapes direct detection. We present in this paper a technique for direct measurement and analysis of light scattering from nanostructures on a surface, exemplified with aperiodic patterns of Ag strips placed on a GaAs substrate. By placing the structures on the flat face of a half-cylinder, the angular distribution of light scattered into the azimuth plane can be directly detected, including directions above the critical angle that would be captured if the substrate had the form of a slab. Modelling of the scattered light by summing up contributions from each strip agrees with the experimental results to a very detailed level, both for scattering backward and into the substrate.
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Chapman W, Roxburgh C, Makhdoom B, Roy A, Youssef F, Brady P, Olsen J, Kim H, Pedersen K, Mutch M, Hunt S, Markovina S, Hajj C, Cercek A, Weiser M, Parikh P. Rectal Cancer Downstaging is Significantly Improved with Different Regimens of Total Neoadjuvant Therapy. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bekaii-Saab T, Ou F, Anderson D, Ahn D, Boland P, Ciombor K, Jacobs N, Desnoyers R, Cleary J, Meyers J, Chiorean E, Pedersen K, Barzi A, Sloan J, McCune J, Lacouture M, Lenz H, Grothey A. Regorafenib Dose Optimization Study (ReDOS): Randomized phase II trial to evaluate escalating dosing strategy and pre-emptive topical steroids for regorafenib in refractory metastatic colorectal cancer (mCRC) – An ACCRU Network study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy149.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Pedersen K, Fogelberg S, Thamsborg LH, Clements M, Nygård M, Kristiansen IS, Lynge E, Sparén P, Kim JJ, Burger EA. An overview of cervical cancer epidemiology and prevention in Scandinavia. Acta Obstet Gynecol Scand 2018; 97:795-807. [PMID: 29388202 DOI: 10.1111/aogs.13313] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 01/19/2018] [Indexed: 11/30/2022]
Abstract
New technologies such as human papillomavirus (HPV) testing and vaccination necessitate comprehensive policy analyses to optimize cervical cancer prevention. To inform future Scandinavian-specific policy analyses, we aimed to provide an overview of cervical cancer epidemiology and existing prevention efforts in Denmark, Norway and Sweden. We compiled and summarized data on current prevention strategies, population demography and epidemiology (for example, age-specific HPV prevalence and cervical cancer incidence over time) for each Scandinavian country by reviewing published literature and official guidelines, performing registry-based analyses using primary data and having discussions with experts in each country. In Scandinavia, opportunistic screening occurred as early as the 1950s and by 1996, all countries had implemented nationwide organized cytology-based screening. Prior to implementation of widespread screening and during 1960-66, cervical cancer incidence was considerably higher in Denmark than in Norway and Sweden. Decades of cytology-based screening later (i.e. 2010-2014), cervical cancer incidence has been considerably reduced and has converged across the countries since the 1960s, although it still remains lowest in Sweden. Generally, Scandinavian countries face similar cervical cancer burdens and utilize similar prevention approaches; however, important differences remain. Future policy analyses will need to evaluate whether these differences warrant differential prevention policies or whether efforts can be streamlined across Scandinavia.
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Affiliation(s)
- Kine Pedersen
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Sara Fogelberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Lise H Thamsborg
- Department of Public Health, Center for Epidemiology & Screening, University of Copenhagen, Copenhagen, Denmark
| | - Mark Clements
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Mari Nygård
- Research Department, The Cancer Registry of Norway, Oslo, Norway
| | - Ivar S Kristiansen
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Elsebeth Lynge
- Department of Public Health, Center for Epidemiology & Screening, University of Copenhagen, Copenhagen, Denmark
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Jane J Kim
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Emily A Burger
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway.,Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Pedersen K, Burger EA, Nygård M, Kristiansen IS, Kim JJ. Adapting cervical cancer screening for women vaccinated against human papillomavirus infections: The value of stratifying guidelines. Eur J Cancer 2018; 91:68-75. [PMID: 29335156 DOI: 10.1016/j.ejca.2017.12.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 12/06/2017] [Accepted: 12/13/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Several countries have implemented vaccination against human papillomavirus (HPV) for adolescent girls and must decide whether and how to adapt cervical cancer (CC) screening for these low-risk women. We aimed to identify the optimal screening strategies for women vaccinated against HPV infections and quantify the amount that could be spent to identify vaccination status among women and stratify CC screening guidelines accordingly. METHODS We used a mathematical model reflecting HPV-induced CC in Norway to project the long-term health benefits, resources and costs associated with 74 candidate-screening strategies that varied by screening test, start age and frequency. Strategies were considered separately for women vaccinated with the bivalent/quadrivalent (2/4vHPV) and nonavalent (9vHPV) vaccines. We used a cost-effectiveness framework (i.e. incremental cost-effectiveness ratios and net monetary benefit) and a commonly-cited Norwegian willingness-to-pay threshold of €75,000 per quality-adjusted life-year gained. RESULTS The most cost-effective screening strategy for 9vHPV- and 2/4vHPV-vaccinated women involved HPV testing once and twice per lifetime, respectively. The value of stratifying guidelines by vaccination status was €599 (2/4vHPV) and €725 (9vHPV) per vaccinated woman. Consequently, for the first birth cohort of ∼22,000 women who were vaccinated in adolescence in Norway, between €10.5-13.2 million over their lifetime could be spent on identifying individual vaccination status and stratify screening while remaining cost-effective. CONCLUSION Less intensive strategies are required for CC screening to remain cost-effective in HPV-vaccinated women. Moreover, screening can remain cost-effective even if large investments are made to identify individual vaccination status and stratify screening guidelines accordingly.
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Affiliation(s)
- Kine Pedersen
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P.O. Box 1089 Blindern, 0317, Oslo, Norway.
| | - Emily A Burger
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P.O. Box 1089 Blindern, 0317, Oslo, Norway; Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave, 2nd Floor, Boston, MA, 02115, USA
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, P.O. Box 5313 Majorstuen, 0304, Oslo, Norway
| | - Ivar S Kristiansen
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P.O. Box 1089 Blindern, 0317, Oslo, Norway
| | - Jane J Kim
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave, 2nd Floor, Boston, MA, 02115, USA
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Burger EA, Pedersen K, Sy S, Kristiansen IS, Kim JJ. Choosing wisely: a model-based analysis evaluating the trade-offs in cancer benefit and diagnostic referrals among alternative HPV testing strategies in Norway. Br J Cancer 2017; 117:783-790. [PMID: 28772279 PMCID: PMC5589995 DOI: 10.1038/bjc.2017.248] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/16/2017] [Accepted: 07/06/2017] [Indexed: 11/23/2022] Open
Abstract
Background: Forthcoming cervical cancer screening strategies involving human papillomavirus (HPV) testing for women not vaccinated against HPV infections may increase colposcopy referral rates. We quantified health and resource trade-offs associated with alternative HPV-based algorithms to inform decision-makers when choosing between candidate algorithms. Methods: We used a mathematical simulation model of HPV-induced cervical carcinogenesis in Norway. We compared the current cytology-based strategy to alternative strategies that varied by the switching age to primary HPV testing (ages 25–34 years), the routine screening frequency (every 3–10 years), and management of HPV-positive, cytology-negative women. Model outcomes included reductions in lifetime cervical cancer risk, relative colposcopy rates, and colposcopy rates per cervical cancer prevented. Results: The age of switching to primary HPV testing and the screening frequency had the largest impacts on cancer risk reductions, which ranged from 90.9% to 96.3% compared to no screening. In contrast, increasing the follow-up intensity of HPV-positive, cytology-negative women provided only minor improvements in cancer benefits, but generally required considerably higher rates of colposcopy referrals compared to current levels, resulting in less efficient cervical cancer prevention. Conclusions: We found that in order to maximise cancer benefits HPV-based screening among unvaccinated women should not be delayed: rather, policy makers should utilise the triage mechanism to control colposcopy referrals.
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Affiliation(s)
- Emily A Burger
- Harvard T.H. Chan School of Public Health, Center for Health Decision Science, 718 Huntington Avenue, 2nd Floor, Boston, MA 02115, USA
| | - Kine Pedersen
- University of Oslo, Department of Health Management and Health Economics, PO BOX 1089 Blindern, Oslo 0317, Norway
| | - Stephen Sy
- Harvard T.H. Chan School of Public Health, Center for Health Decision Science, 718 Huntington Avenue, 2nd Floor, Boston, MA 02115, USA
| | - Ivar Sønbø Kristiansen
- University of Oslo, Department of Health Management and Health Economics, PO BOX 1089 Blindern, Oslo 0317, Norway
| | - Jane J Kim
- Harvard T.H. Chan School of Public Health, Center for Health Decision Science, 718 Huntington Avenue, 2nd Floor, Boston, MA 02115, USA
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Pedersen K, Burger EA, Campbell S, Nygård M, Aas E, Lönnberg S. Advancing the evaluation of cervical cancer screening: development and application of a longitudinal adherence metric. Eur J Public Health 2017; 27:1089-1094. [DOI: 10.1093/eurpub/ckx073] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Pedersen K, Bauer NE, Olsen S, Arenas-Gamboa AM, Henry AC, Sibley TD, Gidlewski T. Identification of Brucella spp. in feral swine (Sus scrofa) at abattoirs in Texas, USA. Zoonoses Public Health 2017; 64:647-654. [PMID: 28391650 DOI: 10.1111/zph.12359] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Indexed: 12/01/2022]
Abstract
Various tissues, nasal swabs, urine and blood samples were collected from 376 feral swine at two federally inspected abattoirs in Texas during six separate sampling periods in 2015. Samples were tested for Brucella spp. by culture and serology. Brucella spp. were cultured from 13.0% of feral swine, and antibodies were detected in 9.8%. Only 32.7% of culture-positive feral swine were also antibody positive, and 43.2% of antibody-positive feral swine were culture positive. Approximately, the same number of males (14.0%) and females (12.1%) were culture positive, and slightly more males (10.5%) than females (8.7%) were antibody positive. Our results indicate that serology likely underestimates the prevalence of feral swine infected, and that those who come in contact with feral swine should be aware of the symptoms of infection with Brucella spp. to ensure prompt treatment.
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Affiliation(s)
- K Pedersen
- U.S. Department of Agriculture, Animal and Plant Health Inspection Service, Wildlife Services, Fort Collins, CO, USA
| | - N E Bauer
- U.S. Department of Agriculture, Food Safety Inspection Service, College Station, TX, USA
| | - S Olsen
- U.S. Department of Agriculture, Agricultural Research Service, Ames, IA, USA
| | - A M Arenas-Gamboa
- Department of Veterinary Pathobiology, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - A C Henry
- U.S. Department of Agriculture, Animal and Plant Health Inspection Service, Wildlife Services, Fort Worth, TX, USA
| | - T D Sibley
- U.S. Department of Agriculture, Animal and Plant Health Inspection Service, Wildlife Services, Fort Worth, TX, USA
| | - T Gidlewski
- U.S. Department of Agriculture, Animal and Plant Health Inspection Service, Wildlife Services, National Wildlife Research Center, Fort Collins, CO, USA
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Mignaqui A, Marcellino R, Ronco T, Pappalardo J, Nonnemann B, Pedersen K, Robles C. Isolation and molecular characterization of Clostridium perfringens from healthy Merino lambs in Patagonia region, Argentina. Anaerobe 2017; 43:35-38. [DOI: 10.1016/j.anaerobe.2016.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/18/2016] [Accepted: 10/30/2016] [Indexed: 10/20/2022]
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Kjeldsen MK, Torpdahl M, Pedersen K, Nielsen EM. Development and comparison of a generic multiple-locus variable-number tandem repeat analysis with pulsed-field gel electrophoresis for typing of Salmonella enterica subsp. enterica. J Appl Microbiol 2016; 119:1707-17. [PMID: 26440858 DOI: 10.1111/jam.12965] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/10/2015] [Accepted: 09/17/2015] [Indexed: 11/28/2022]
Abstract
AIMS Salmonella enterica subsp. enterica causes salmonellosis in humans and animals. Serovar-specific multiple-locus variable-number tandem repeat analysis (MLVA) is widely used for Salmonella surveillance; however, isolates have to be serotyped prior to MLVA typing and only the most common serovars can be typed. We developed a MLVA scheme for high-discriminatory typing of Salmonella. METHODS AND RESULTS Sixty-six unique VNTRs were investigated and the polymorphisms of seven promising VNTRs were evaluated with a panel 163 diverse isolates of 14 serotypes of significance for human health. Five VNTRs were selected for MLVA analysis. The discriminatory power was evaluated within serovars by 163 isolates and MLVA yielded 79 genotypes (DI of 0·9790) and pulsed-field gel electrophoresis (PFGE) revealed 87 genotypes (DI of 0·9989). MLVA divided each serotype into 2-8 different profiles and identified six pairs of outbreak-related strains. CONCLUSIONS The technique showed a high-discriminatory power within most serotypes comparable with or better than that of PFGE. SIGNIFICANCE AND IMPACT OF THE STUDY This MLVA assay makes it possible to use a single typing method for Salmonella surveillance and outbreak investigations. This allows inexpensive and fast surveillance for laboratories without resources for both serotyping and molecular typing, e.g. PFGE or sequence-based methods, and thereby improve the effectiveness of epidemiological investigations of Salmonella infections globally.
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Affiliation(s)
- M K Kjeldsen
- The Unit for Foodborne Infections, Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark.,National Food Institute, Technical University of Denmark, Søborg, Denmark
| | - M Torpdahl
- The Unit for Foodborne Infections, Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - K Pedersen
- National Veterinary Institute, Technical University of Denmark, Frederiksberg, Denmark
| | - E M Nielsen
- The Unit for Foodborne Infections, Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
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Melberg HO, Beck Olsen C, Pedersen K. Did hospitals respond to changes in weights of Diagnosis Related Groups in Norway between 2006 and 2013? Health Policy 2016; 120:992-1000. [DOI: 10.1016/j.healthpol.2016.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 07/01/2016] [Accepted: 07/19/2016] [Indexed: 11/29/2022]
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Enlund A, Pedersen K, Boeryd B, Varenhorst E. Transrectal Ultrasonography Compared to Histopathological Assessment for Local Staging of Prostatic Carcinoma. Acta Radiol 2016. [DOI: 10.1177/028418519003100613] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Transrectal ultrasonography (US) was used to predict tumor stage prior to radical prostatectomy in 59 patients with clinically localized carcinoma of the prostate. In 35 cases, US-guided biopsy was done. Histopathological examination of whole tissue mounts was compared with US findings in 49 cases. The remaining 10 had US-guided biopsies proving extracapsular extension of the tumor. Tumor size, as measured by US, was inadequate to distinguish between organ-confined disease and locally advanced tumor. Strategically taken US-guided biopsies of the periprostatic tissue or seminal vesicles were necessary. In the first 30 (group I) in this series of 59 cases, 18 of 22 tumors with extraprostatic spread (pT3) were understaged. In the last 29 cases (group II) only 6 of 19 pT3 tumors were understaged. After an initial training period, transrectal US, in combination with US-guided biopsy, can prove valuable for the pretherapeutic assessment of local spread of prostatic cancer, and can thus aid in the choice of appropriate treatment.
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Pedersen K, Burger EA, Sy S, Kristiansen IS, Kim JJ. Cost-effective management of women with minor cervical lesions: Revisiting the application of HPV DNA testing. Gynecol Oncol 2016; 143:326-333. [PMID: 27542966 DOI: 10.1016/j.ygyno.2016.08.231] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 08/03/2016] [Accepted: 08/04/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lack of consensus in management guidelines for women with minor cervical lesions, coupled with novel screening approaches, such as human papillomavirus (HPV) genotyping, necessitate revisiting prevention policies. We evaluated the cost-effectiveness and resource trade-offs of alternative triage strategies to inform cervical cancer prevention in Norway. METHODS We used a decision-analytic model to compare the lifetime health and economic consequences associated with ten novel candidate approaches to triage women with minor cervical lesions. Candidate strategies varied by: 1) the triage test(s): HPV testing in combination with cytology, HPV testing alone with or without genotyping for HPV-16 and -18, and immediate colposcopy, and 2) the length of time between index and triage testing (i.e., 6, 12 or 18months). Model outcomes included quality-adjusted life-years (QALYs), lifetime societal costs, and resource use (e.g., colposcopy referrals). RESULTS The current Norwegian guidelines were less effective and more costly than candidate strategies. Given a commonly-cited willingness-to-pay threshold in Norway of $100,000 per QALY gained, the preferred strategy involved HPV genotyping with immediate colposcopy referral for HPV-16 or -18 positive and repeat HPV testing at 12months for non-HPV-16 or -18 positive ($78,010 per QALY gained). Differences in health benefits among candidate strategies were small, while resource use varied substantially. More effective strategies required a moderate increase in colposcopy referrals (e.g., a 9% increase for the preferred strategy) compared with current levels. CONCLUSION New applications of HPV testing may improve management of women with minor cervical lesions, yet are accompanied by a trade-off of increased follow-up procedures.
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Affiliation(s)
- Kine Pedersen
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P.O. Box 1089 Blindern, 0317 Oslo, Norway
| | - Emily A Burger
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P.O. Box 1089 Blindern, 0317 Oslo, Norway; Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave, 2nd Floor, Boston, MA 02115, USA.
| | - Stephen Sy
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave, 2nd Floor, Boston, MA 02115, USA
| | - Ivar S Kristiansen
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P.O. Box 1089 Blindern, 0317 Oslo, Norway
| | - Jane J Kim
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave, 2nd Floor, Boston, MA 02115, USA
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Pedersen K, Sørbye SW, Kristiansen IS, Burger EA. Using novel biomarkers to triage young adult women with minor cervical lesions: a cost-effectiveness analysis. BJOG 2016; 124:474-484. [PMID: 27264207 DOI: 10.1111/1471-0528.14135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the short-term consequences and cost-effectiveness associated with the use of novel biomarkers to triage young adult women with minor cervical cytological lesions. DESIGN Model-based economic evaluation using primary epidemiological data from Norway, supplemented with data from European and American clinical trials. SETTING Organised cervical cancer screening in Norway. POPULATION Women aged 25-33 years with minor cervical cytological lesions detected at their primary screening test. METHODS We expanded an existing simulation model to compare 12 triage strategies involving alternative biomarkers (i.e. reflex human papillomavirus (HPV) DNA/mRNA testing, genotyping, and dual staining) with the current Norwegian triage guidelines. MAIN OUTCOME MEASURES The number of high-grade precancers detected and resource use (e.g. monetary costs and colposcopy referrals) for a single screening round (3 years) for each triage strategy. Cost-efficiency, defined as the additional cost per additional precancer detected of each strategy compared with the next most costly strategy. RESULTS Five strategies were identified as cost-efficient, and are projected to increase the precancer detection rate between 18 and 57%, compared with current guidelines; however, the strategies did not uniformly require additional resources. Strategies involving HPV mRNA testing required fewer resources, whereas HPV DNA-based strategies detected >50% more precancers, but were more costly and required twice as many colposcopy referrals compared with the current guidelines. CONCLUSION Strategies involving biomarkers to triage younger women with minor cervical cytological lesions have the potential to detect additional precancers, yet the optimal strategy depends on the resources available as well as decision-makers' and women's acceptance of additional screening procedures. TWEETABLE ABSTRACT Women with minor cervical lesions may be triaged more accurately and effectively using novel biomarkers.
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Affiliation(s)
- K Pedersen
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - S W Sørbye
- Department of Clinical Pathology, University Hospital of North Norway, Tromsø, Norway
| | - I S Kristiansen
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - E A Burger
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway.,Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Pedersen K, Irwin J, Sansourekidou P, Kriminski S, Pavord D. SU-F-T-509: Investigation into the Impact of the Linear Accelerator Treatment Table On Skin Dose to Prone Breast Patients. Med Phys 2016. [DOI: 10.1118/1.4956694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Van Immerseel F, Lyhs U, Pedersen K, Prescott JF. Recent breakthroughs have unveiled the many knowledge gaps inClostridium perfringens-associated necrotic enteritis in chickens: the first International Conference on Necrotic Enteritis in Poultry. Avian Pathol 2016; 45:269-70. [DOI: 10.1080/03079457.2016.1166857] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pedersen K, Sørbye SW, Burger EA, Lönnberg S, Kristiansen IS. Using Decision-Analytic Modeling to Isolate Interventions That Are Feasible, Efficient and Optimal: An Application from the Norwegian Cervical Cancer Screening Program. Value Health 2015; 18:1088-1097. [PMID: 26686795 DOI: 10.1016/j.jval.2015.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 07/10/2015] [Accepted: 08/03/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Decision makers often need to simultaneously consider multiple criteria or outcomes when deciding whether to adopt new health interventions. OBJECTIVES Using decision analysis within the context of cervical cancer screening in Norway, we aimed to aid decision makers in identifying a subset of relevant strategies that are simultaneously efficient, feasible, and optimal. METHODS We developed an age-stratified probabilistic decision tree model following a cohort of women attending primary screening through one screening round. We enumerated detected precancers (i.e., cervical intraepithelial neoplasia of grade 2 or more severe (CIN2+)), colposcopies performed, and monetary costs associated with 10 alternative triage algorithms for women with abnormal cytology results. As efficiency metrics, we calculated incremental cost-effectiveness, and harm-benefit, ratios, defined as the additional costs, or the additional number of colposcopies, per additional CIN2+ detected. We estimated capacity requirements and uncertainty surrounding which strategy is optimal according to the decision rule, involving willingness to pay (monetary or resources consumed per added benefit). RESULTS For ages 25 to 33 years, we eliminated four strategies that did not fall on either efficiency frontier, while one strategy was efficient with respect to both efficiency metrics. Compared with current practice in Norway, two strategies detected more precancers at lower monetary costs, but some required more colposcopies. Similar results were found for women aged 34 to 69 years. CONCLUSIONS Improving the effectiveness and efficiency of cervical cancer screening may necessitate additional resources. Although efficient and feasible, both society and individuals must specify their willingness to accept the additional resources and perceived harms required to increase effectiveness before a strategy can be considered optimal.
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Affiliation(s)
- Kine Pedersen
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | | | - Emily Annika Burger
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway; Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA
| | - Stefan Lönnberg
- The Norwegian Cervical Cancer Screening Program, The Cancer Registry of Norway, Oslo, Norway
| | - Ivar Sønbø Kristiansen
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
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Pedersen K, Majithia N, Eickoff R, Looker S, Thanarajasingam G, Grothey A. PD-008 Safety and efficacy of desensitization protocols for platinum hypersensitivity reactions. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv234.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pedersen K. Kostnad-nytte-avveininger i screening mot livmorhalskreft. Tidsskriftet 2015; 135:1022-3. [DOI: 10.4045/tidsskr.15.0468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Wik DR, Hornstrup A, Molendi S, Madejski G, Harrison FA, Zoglauer A, Grefenstette BW, Gastaldello F, Madsen KK, Westergaard NJ, Ferreira DDM, Kitaguchi T, Pedersen K, Boggs SE, Christensen FE, Craig WW, Hailey CJ, Stern D, Zhang WW. NuSTAROBSERVATIONS OF THE BULLET CLUSTER: CONSTRAINTS ON INVERSE COMPTON EMISSION. ACTA ACUST UNITED AC 2014. [DOI: 10.1088/0004-637x/792/1/48] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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