ABNORMAL PAP SMEARS--WHAT IS COST EFFECTIVE MANAGEMENT?

适当处理边缘和低度异常， 巴氏涂片是高度争议。 筛查的目的是 预防浸润性宫颈癌，同时最大限度地减少身体和 心理疾病以及不必要的资源使用。 这 项目将建立一个成本效益管理模式， 与对照组相比， 阴道镜检查和活检是一种更保守治疗方法 重复子宫颈抹片检查随访策略。 数据纳入 模型将来自结构化的文献综述和Meta， 分析，并从数据收集进行了合作， 萨克拉门托山谷（PPSV）的父母。 数据收集将包括 回顾性估计患者对推荐随访的依从性， 阴道镜检查或重复巴氏涂片，细胞学与组织学的相关性， 确定低级别或临界巴氏涂片的可能性， 从宫颈高度病变和临床评价 在阴道镜检查时重复巴氏涂片的有用性。 成本 对于替代战略将从两个费用进行评估， 服务和管理式护理的观点，以及患者偏好的数据将 前瞻性地收集。 200名女病人在PPSV诊所 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Meta中得出， 分析和所描述的原始研究。 不可能的概率 由这些方法中的任何一种确定的， 使用修改的德尔菲方法。 模型成果将包括 发生浸润性宫颈癌，进展为高级别 宫颈肿瘤，与诊断评估相关的发病率， 治疗和质量调整生命年。 宫颈癌的治疗方法 或避免了高级别病变，每增加一个质量调整生命年 将被计算。 每种癌症或高级别病变的边际成本 避免和质量调整生命年获得更有效的 战略将被计算。

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.