ABNORMAL PAP SMEARS--WHAT IS COST EFFECTIVE MANAGEMENT?

临界性和低度异常的合理管理 Papanicolaou(PAP)涂片极具争议。筛查的目标是 预防浸润性宫颈癌，同时最大限度地减少身体和 心理障碍以及对资源的不必要使用。这 项目将构建管理的成本效益模型 有交界性和低度异常宫颈涂片的患者，对比a 更保守的立即阴道镜检查和活检的策略 重复宫颈涂片的随访策略。要包括在 模型将从结构化的文献回顾和元数据中衍生出来 分析，并来自与计划的合作进行的数据收集 萨克拉门托山谷的父母(PPSV)。数据收集将包括 对患者对推荐的随访的依从性的回顾评估 阴道镜或重复纸片涂片，细胞学与组织学的相关性 确定导致低等级或交界性纸片涂片概率 宫颈高度病变的诊断和临床评价 阴道镜检查时重复做宫颈涂片是否有用。费用 对于替代战略，将从以下两个方面进行评估 服务和管理式医疗角度，以及有关患者偏好的数据将 被前瞻性地收集。PPSV诊所的200名女性患者 将接受采访，并将正式评估患者的偏好 使用直接缩放和时间权衡方法。 模型的概率和成本将从元数据中得出 所述的分析和原创性研究。不可能的概率 根据这些方法中的任何一种确定的结果将由一个专家小组进行评估 使用改进的Delphi方法。模型成果将包括 浸润性宫颈癌的发展，向高级别进展 宫颈肿瘤、与诊断评估相关的发病率和 治疗，和质量调整后的寿命年。每例宫颈癌的成本 或高级别病变避免，并获得每质量调整的生命年 将会被计算出来。每种癌症或高级别病变的边际成本 避免和质量调整的寿命年获得更有效的 战略将被计算出来。

Appropriate management of borderline nd low grade abnormalities on Papanicolaou (pap) smears is high controversial. The goal of screening is to prevent invasive cervical cancers while minimizing physical and psychological morbidity as well as unnecessary use of resources. This project will construct a cost-effectiveness model of the management of patients with borderline and low grade abnormal pap smears, contrasting a strategy of immediate colposcopy and biopsy wit a more conservative strategy of follow-up with repeat pap smears. Data to be included in the model will be derived from a structured literature review and meta- analysis, and from data collection conducted in collaboration with Planned Parenthood of Sacramento Valley (PPSV). Data collection will include retrospective estimation of patient adherence to recommended follow-up for colposcopy or repeat pap smears, correlation of cytology with histology to determine the probability of a low grade or borderline pap smear resulting from a high grade lesion on the cervix and evaluation of the clinical usefulness of repeating the pap smear at the time of colposcopy. Costs for the alternative strategies will be evaluated from both a fee for service and managed care perspective, and data on patient preferences will be collected prospectively. Two hundred women patients at PPSV clinics will be interviewed, and patient preferences will be formally assessed using direct scaling and time trade-off methods. Probabilities and costs for the models will be derived from the meta- analysis and original studies as described. Probabilities which cannot be determined from any of these methods will be estimated by an expert panel using a modified Delphi approach. Model outcomes will include the development of invasive cervical cancer, progression to high grade cervical neoplasia, morbidity related to diagnostic evaluations and treatment, and quality adjusted life years. The cost per cervical cancer or high grade lesion avoided, and per quality adjusted life year gained will be calculated. The marginal cost per cancer or high grade lesion avoided and quality adjusted life year gained for the more effective strategy will be calculated.