Limits...
A survey of population-based utility scores for cervical cancer prevention.

Simonella L, Howard K, Canfell K - BMC Res Notes (2014)

Bottom Line: States involving an HPV positive result with a subsequent normal cytology or colposcopy were ranked below those for low grade cytological abnormalities with or without a subsequent colposcopic normal result (ranks 3-4 vs. 4-5).No significant differences in scores were identified between age groups.However, this difference was minimal on the utility scale, as most values for health states were largely clustered.

View Article: PubMed Central - PubMed

Affiliation: Cancer Research Division, Cancer Council NSW, Woolloomooloo, Australia. k.canfell@unsw.edu.au.

ABSTRACT

Background: With human papillomavirus (HPV) vaccination introduced in a number of countries, there is considerable interest in evaluating the cost-effectiveness of HPV testing as the primary cervical screening test in these settings. However, the availability of utility scores for these newer interventions is limited. Our aim in this paper is to present utility scores for HPV vaccination, HPV testing and cytology based screening states among women targeted for cervical screening.

Methods: We invited a random sample of women targeted for cervical screening (aged 20-69 years) living in Sydney, Australia, to participate in a face-to-face interview. Participants were asked to indicate preferences (rank and utility scores) for 10 hypothetical health states relating to HPV vaccination, cytology and primary HPV screening, cervical precursor disease and early stage cervical cancer. Preferences for hypothetical health states were measured through ranking then a two-stage standard gamble. Each participant's own health state was measured as a utility score using the EQ5D. Potential differences by age were assessed using the Wilcox Rank Sum test.

Results: A maximum of 276 women were contacted, of which 43 (mean age 49 years) agreed to be interviewed (15.6%). The overall health state of women as measured by the EQ5D was 0.86 (95% CI: 0.83-0.89). Of the 10 health states, the highest ranked were 'normal cytology' and 'HPV vaccination' (equal 1st). States involving an HPV positive result with a subsequent normal cytology or colposcopy were ranked below those for low grade cytological abnormalities with or without a subsequent colposcopic normal result (ranks 3-4 vs. 4-5). However, mean utility scores were broadly similar for all health states, except cervical cancer. No significant differences in scores were identified between age groups.

Conclusion: Our survey suggests health states relating to HPV testing are ranked below 'low grade cytology' disease abnormalities. However, this difference was minimal on the utility scale, as most values for health states were largely clustered. These results provide a preliminary set of non-clinic population-based utilities that may be used with other values to explore the economic implications of introducing HPV testing as a primary screening tool in the context of HPV vaccination.

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Conceptual outline of two-stage standard gamble.
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Fig1: Conceptual outline of two-stage standard gamble.

Mentions: A two-stage standard gamble was used to assess the utility for each hypothetical health state. The assessment process used two stages; Stage 1 derives probability indifference scores (utilities) for each of the nine health states, measured relative to risky prospects between perfect health and early stage cervical cancer, while Stage 2 derives a probability indifference score for early stage cervical cancer measured relative to the risky prospects associated with either perfect health or death (Figure 1) [20]. For stage 2, we evaluated cervical cancer twice using two distinct ‘time in state’ scales (see below). Thus each participant provided 11 health state preference scores; nine for each temporary health state, two for early stage cervical cancer. By valuing temporary health states that do not involve any likely prospect of death (i.e. the non-cancer states), ‘ceiling effects’ for the hypothetical health states are potentially minimised [21]. The two-stage standard gamble has been adopted in previous assessments of cervical cancer prevention [15, 22, 23].Figure 1


A survey of population-based utility scores for cervical cancer prevention.

Simonella L, Howard K, Canfell K - BMC Res Notes (2014)

Conceptual outline of two-stage standard gamble.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4307910&req=5

Fig1: Conceptual outline of two-stage standard gamble.
Mentions: A two-stage standard gamble was used to assess the utility for each hypothetical health state. The assessment process used two stages; Stage 1 derives probability indifference scores (utilities) for each of the nine health states, measured relative to risky prospects between perfect health and early stage cervical cancer, while Stage 2 derives a probability indifference score for early stage cervical cancer measured relative to the risky prospects associated with either perfect health or death (Figure 1) [20]. For stage 2, we evaluated cervical cancer twice using two distinct ‘time in state’ scales (see below). Thus each participant provided 11 health state preference scores; nine for each temporary health state, two for early stage cervical cancer. By valuing temporary health states that do not involve any likely prospect of death (i.e. the non-cancer states), ‘ceiling effects’ for the hypothetical health states are potentially minimised [21]. The two-stage standard gamble has been adopted in previous assessments of cervical cancer prevention [15, 22, 23].Figure 1

Bottom Line: States involving an HPV positive result with a subsequent normal cytology or colposcopy were ranked below those for low grade cytological abnormalities with or without a subsequent colposcopic normal result (ranks 3-4 vs. 4-5).No significant differences in scores were identified between age groups.However, this difference was minimal on the utility scale, as most values for health states were largely clustered.

View Article: PubMed Central - PubMed

Affiliation: Cancer Research Division, Cancer Council NSW, Woolloomooloo, Australia. k.canfell@unsw.edu.au.

ABSTRACT

Background: With human papillomavirus (HPV) vaccination introduced in a number of countries, there is considerable interest in evaluating the cost-effectiveness of HPV testing as the primary cervical screening test in these settings. However, the availability of utility scores for these newer interventions is limited. Our aim in this paper is to present utility scores for HPV vaccination, HPV testing and cytology based screening states among women targeted for cervical screening.

Methods: We invited a random sample of women targeted for cervical screening (aged 20-69 years) living in Sydney, Australia, to participate in a face-to-face interview. Participants were asked to indicate preferences (rank and utility scores) for 10 hypothetical health states relating to HPV vaccination, cytology and primary HPV screening, cervical precursor disease and early stage cervical cancer. Preferences for hypothetical health states were measured through ranking then a two-stage standard gamble. Each participant's own health state was measured as a utility score using the EQ5D. Potential differences by age were assessed using the Wilcox Rank Sum test.

Results: A maximum of 276 women were contacted, of which 43 (mean age 49 years) agreed to be interviewed (15.6%). The overall health state of women as measured by the EQ5D was 0.86 (95% CI: 0.83-0.89). Of the 10 health states, the highest ranked were 'normal cytology' and 'HPV vaccination' (equal 1st). States involving an HPV positive result with a subsequent normal cytology or colposcopy were ranked below those for low grade cytological abnormalities with or without a subsequent colposcopic normal result (ranks 3-4 vs. 4-5). However, mean utility scores were broadly similar for all health states, except cervical cancer. No significant differences in scores were identified between age groups.

Conclusion: Our survey suggests health states relating to HPV testing are ranked below 'low grade cytology' disease abnormalities. However, this difference was minimal on the utility scale, as most values for health states were largely clustered. These results provide a preliminary set of non-clinic population-based utilities that may be used with other values to explore the economic implications of introducing HPV testing as a primary screening tool in the context of HPV vaccination.

Show MeSH
Related in: MedlinePlus