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Objective: Recently generated randomized screening trial data have provided good evidence in favour of routine screening for abdominal aortic aneurysm (AAA) to reduce AAA-related deaths in men aged 65 years [...]

Chlamydia is the most common sexually transmitted infection in the UK and constitutes a major public health problem. The UK Department of Health is phasing in a National Chlamydia Screening Programme (NCSP) but there is concern that blanket screening of the entire at risk population will simply add extra burden to the already overstretched health economy. This paper demonstrates that certain high-risk sub-groups within the general population are critical in the infection dynamics. Improved targeting of these high-risk populations achieves greater cost-effectiveness. Statistical risk-group clustering techniques have been used to identify indicators that are strong predictors in determining high-risk status while geomapping techniques visually display prevalence geographically across the region, thus identifying high prevalence postcode clusters and informing public health planners where to target intervention and screening strategies. A System Dynamics simulation model has been used to capture the infection dynamics and measure the cost-effectiveness of the intervention strategies. The model incorporates risk-group behaviour as identified by the above geomapping and statistical analysis components of the research. The combined use of computer simulation, statistical analysis and geomapping methodologies has provided a unique holistic view of the problem. Journal of the Operational Research Society (2006) 57, 1400-1412. doi: 10. 1057/palgrave.j ors.2602134 Keywords: healthcare; Chlamydia; system dynamics; geomapping; risk grouping

Computer-based models are used to assess the cost-effectiveness of a variety of cervical-cancer screening strategies in India, Kenya, Peru, South Africa, and Thailand. Cervical-cancer screening strategies incorporating visual inspection of the cervix with acetic acid or DNA testing for HPV in one or two clinical visits are cost-effective alternatives to conventional three-visit cytology-based screening programs in resource-poor settings.

Background. Health screening programs can be represented as a pathway of sequential processes: offering a test, obtaining consent, conducting the test, providing results, and linking to appropriate care. Using the [...]

Screening all Americans for protein in the urine beginning at the age of 50 and every year after is not cost-effective, according to researchers who used a Markov decision analytic model to compare various screening strategies. It would be more cost-effective to screen only those 60 years old or older and those with high blood pressure. Protein in the urine is a sign of kidney disease, which is more easily treated if detected early.

Direct-to-consumer marketing of helical CT scans for detecting lung cancer in current and former smokers is not cost-effective, according to researchers who used computer simulation on a hypothetical group of 100,000 current or former smokers. Helical CT scans are very expensive and they may find lung abnormalities that are not cancerous. This false-positive result would lead to additional invasive tests, with no benefit to the patient.

Objective. To evaluate the costs and benefits of a group B streptococci screening strategy using a new, rapid polymerase chain reaction test in a hypothetical cohort of expectant mothers in the United States. Methods. Design. Cost-benefit analysis using the human capital method. We developed a decision model to analyze the costs and benefits of a hypothetical group B streptococci screening strategy using a new, rapid polymerase chain reaction test as compared with the currently recommended group B streptococci screening guidelines--prenatal culture performed at 35 to 37 weeks or risk-factor-based strategy with subsequent intrapartum treatment of the expectant mothers with antibiotics to prevent early-onset group B streptococcal infections in their infants. Participants. A hypothetical cohort of pregnant women and their newborns. Interventions. Screening strategies for group B streptococci using the new polymerase chain reaction technique, the 35- to 37-week culture, or maternal risk factors. Outcome Measures. Infant infections averted, infant deaths, infant disabilities, costs, and societal benefits of healthy infants. Results. A screening strategy using the new polymerase chain reaction test generates a net benefit of $7 per birth when compared with the maternal risk-factor strategy. For every 1 million births, 80 700 more women would receive antibiotics, 884 fewer infants would become infected with early-onset group B streptococci, and 23 infants would be saved from death or disability. The polymerase chain reaction-based strategy generates a net benefit of $6 per birth when compared with the 35- to 37-week prenatal culture strategy and results in fewer maternal courses of antibiotics (64 080 per million births), fewer perinatal infections with early-onset group B streptococci (218/million), and a reduction in 6 infant deaths and severe infant disability per million births. The benefits hold over a wide range of assumptions regarding key factors in the analysis. Conclusions. Although additional clinical trials are needed to establish the accuracy of this new polymerase chain reaction test, initial studies suggest that strategies using this test will be superior to the other 2 strategies. Using the rapid polymerase chain reaction test becomes less attractive as the cost of the test increases. The test's greatest strengths lie in its ability to identify women and infants at risk at the time of labor, thereby decreasing the number of false-positives and false-negatives seen with the other 2 strategies and allowing for more accurate and effective intrapartum prophylaxis. Pediatrics 2002; 110:471-480; Streptococcus agalactiae, streptococcal infections, mass screening, cost-benefit analysis., ABBREVIATIONS. GBS, group B [beta]-hemolytic Streptococcus; EOGBS, early-onset group B streptococcal (disease); AAP, American Academy of Pediatrics; CDC, Centers for Disease Control and Prevention; PCR, polymerase chain reaction; NICU, neonatal [...]

The most cost-effective way to screen women for cervical cancer is to give them a Pap test and a human papillomavirus test every two years until the age of 65 or 70. Human papillomavirus has been linked to cervical cancer., Context: Despite quality assurance standards, Papanicolaou (Pap) test characteristics remain less than optimal. Objective: To compare the societal costs and benefits of human papillomavirus (HPV) testing, Pap testing, and their combination to screen for cervical cancer. Design, Setting, and Population: A simulation model of neoplasia natural history was used to estimate the societal costs and quality-adjusted life expectancy associated with 18 different general population screening strategies: Pap plus HPV testing, Pap testing alone, and HPV testing alone every 2 or 3 years among hypothetical longitudinal cohorts of US women beginning at age 20 years and continuing to 65 years, 75 years, or death. Main Outcome Measure: Discounted costs per quality-adjusted life-year (QALY) saved of each screening strategy. Results: Maximal savings in lives were achieved by screening every 2 years until death with combined HPV and Pap testing at an incremental cost of $76183 per QALY compared with Pap testing alone every 2 years. Stopping biennial screening with HPV and Pap testing at age 75 years captures 97.8% of the benefits of lifetime screening at a cost of $70347 per QALY. Combined biennial HPV and Pap testing to age 65 years captures 86.6% of the benefits achievable by continuing to screen until age 75 years. Human papillomavirus screening alone was equally effective as Pap testing alone at any given screening interval or age of screening cessation but was more costly and therefore was dominated. In sensitivity analyses, HPV testing would be more effective and less costly than Pap testing at a cost threshold of $5 for an HPV test. Conclusions: Screening with HPV plus Pap tests every 2 years appears to save additional years of life at reasonable costs compared with Pap testing alone. Applying age limits to screening is a viable option to maintain benefits while reducing costs.

OBJECTIVE: To assess the cost-effectiveness of adding school based Mantoux screening programs to the New South Wales current TB prevention strategy. METHOD: A decision analysis model compared the costs and consequences of screening strategies against the current no-screen strategy, Costs associated with screening and with treating future cases of TB were considered. Consequences considered were deaths and adult cases of TB prevented. The study was based on data from prevalence surveys conducted in 1992 and 1994 in Central and South Western Sydney, New South Wales. Screening strategies considered were screening all or only overseas born (OSB) 6 year olds and all or only OSB 14 year olds in school settings. RESULTS: Screening 14 year olds prevented more deaths and adult cases of TB than screening 6 year olds for a similar cost. For both age groups targeted screening of OSB children was more cost-effective than screening all children. Targeted screening of 14 year olds - the most cost effective option - cost $17,956 (costs and benefits discounted at 5%) per adult case prevented, equivalent to approximately $130,000 per life year saved. The cost-effectiveness ratios decline substantially if lower discount rates and less conservative assumptions are applied. CONCLUSION: Targeted screening was more cost effective than screening all children, however, there are ethical implications of targeting a group based on their origin of birth. IMPLICATIONS: As prevention and control of TB continues to be a high priority for NSW, the implications of a school based screening program should be seriously considered.

Setting a reasonable cutoff level for screening premature infants for retinopathy of prematurity (ROP) could save more than $1.5 million a year without missing any cases of ROP beyond Stage I. In examining 707 infants, no ROP beyond Stage I was found in infants gestated 32 weeks or more or with birth weights of 1500 grams or more. This amounted to 34.2% fewer screenings needed. Using a lower cutoff of 28 weeks would miss some infants with more advanced retinopathy., Objective. To determine appropriate upper limits for gestational age and birth weight when screening infants for retinopathy of prematurity (ROP). Design. Retrospective survey. Setting. Tertiary neonatal intensive care nursery. Patients. Seven hundred seven infants born July 1, 1990 to June 30, 1996 and screened for ROP according to the 1988 to 1996 American Academy of Pediatrics guidelines. Outcome Measures. Maximum stage of ROP with respect to birth weight and gestational age. Results. No ROP more than Stage 1 was observed in infants with gestational ages [is greater than or equal to] 32 weeks or birth weights 1500 g. All cases of threshold and Stage 4 ROP were confined to infants with gestational ages [is less than or equal to] 30 weeks or birth weights [is less than] 1200 g. Conclusions. The latest American Academy of Pediatrics screening guidelines for ROP are discretionary for infants with birth weights [is greater than] 1500 g or gestational ages [is greater than] 28 weeks. If ROP screening is limited to infants with birth weights of [is less than or equal to] 1500 g, 34.2% fewer infants would require screening compared with the previous [is less than] 1800 g recommendation, while missing no cases of ROP more than Stage 1. A gestational age cut-off of [is less than or equal to] 28 weeks, however, is less desirable, and could potentially miss several infants with more advanced retinopathy (including Stage 4). If ROP screening criteria were instead modified to include infants of gestational ages [is less than] 32 weeks, the number of patients requiring screening could be reduced 29.1% compared with the previous recommendation of [is less than] 35 weeks, again without missing any cases of ROP more than Stage 1. Use of such a screening strategy (birth weight [is less than] 1500 g or gestational age [is less than] 32 weeks) is predicted to save in excess of 1.5 million dollars annually in the United States, while missing no cases of ROP more than Stage 1. Pediatrics 1998;102:31-34; retinopathy of prematurity. ABBREVIATIONS. AAP, American Academy of Pediatrics; ROP, retinopathy of prematurity; CI, confidence interval., The American Academy of Pediatrics (AAP), the American Association for Pediatric Ophthalmology and Strabismus, and the American Academy of Ophthalmology together have recently recommended new screening guidelines for the timely [...]

Newborn infants are routinely screened at birth in the United States for a variety of congenital disorders. The purpose of screening is to reduce morbidity and mortality associated with these […]