1. (45 pts total) An article in JAMA by Mandelblatt et al (2002) compared the so

Question

1. (45 pts total) An article in JAMA by Mandelblatt et al (2002) compared the societal costs and benefits of human papillomavirus (HPV) testing, Pap testing, and their combination to screen for cervical cancer. The following table summarizes some of the results (low cost to high cost Costs include screening and treatment costs discounted over the individual's expected lifetime trategy ost LYs ost LY E ratio ICER No screening 5,000 26.87 . Pap every 3 years6,82527.02 every 3 years 6,950 27.02 Pap every 2 years 7,275 27.04 Pap + HPV every 7,400 27.04 HPV every 2 years 7,450 27.04 Pap + HPV every7,925 27.05 HPV to 75 to age 75 s to age 75 a. (6 pts.) Identify all dominated screening strategies. Recall a strategy is dominated if it costs more than an equally or more effective strategy, or it is less effective than another strategy that costs the same or less. List the strategy number(s) here b. (36 pts.) Fill in the table above. Calculate the incremental cost, incremental QALYs, and ICERs for all economically rational strategies (relative to strategy 0, no screening). c. (3 pts.) The local health district has asked your opinion on the "bes? strategy from a public health perspective. What do you tell them?

Explanation / Answer

Ans b. Fill the Table

Here in above ques QALY is the quality-adjusted life year or quality-adjusted life-year (QALY) which is a generic measure of disease burden, including both the quality and the quantity of life lived. It is used in economic evaluation to assess the value for money of medical interventions. One QALY equates to one year in perfect health.

Strategy Cost QALY Incrementl Cost Incremental QALY Incremental CE Ratio
0 5000 26.87 ----- ----- ----
1 6825 27.02 1825 0.15 12166.66
2 6950 27.02 125 00 00
3 7275 27.04 325 0.02 16250
4 7400 27.04 125 00 00
5 7450 27.04 50 00 00
6 7925 27.05 475 0.01 47500

Ans a.for the Case of dominance We will immediately delete the Strategy 6 because it carries huge cost and QALY is very little, so it is highly dominated, same is the case with the strategy 3 so we will delete it the next.And so on because if QALY is very less than it is useless to add cost.

Ans c, Best strategy is first and second but only if the cost of 12166 is accepted, otherwise local health district can go forward with Strategy 0 of no screening.

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