Alternative management strategies that have been adopted in many high-income settings are to offer immediate colposcopy
referral or to utilise human papillomavirus (HPV) DNA testing as a triage for colposcopy referral, and to consider different strategies according to women’s age. The objective of our study was to evaluate the lifetime cost effectiveness in terms of cost per years of life saved (YLS) of these alternative strategies for a middle income setting. A Markov model was developed using data from the Ludwig-McGill cohort and calibrated to independent observational datasets and local cost estimates obtained. In the BTSA1 chemical structure base-case analysis, repeat cytology was the least costly strategy but also the least effective.
Based on the WHO threshold for very cost-effective interventions, HPV triage for women above 30 years-old was the strategy with the highest probability of being cost effective. HPV triage including younger women with ASCUS results would also be a cost-effective option. Whilst there was a slight further gain in effectiveness with immediate colposcopy referral, it was also more expensive and did not appear to be cost effective. Threshold analysis indicated that an HPV test would have to be more than twice as expensive as a cytology test for HPV triage to no longer be cost effective. In conclusion, our results indicate that in MX69 order middle income settings HPV triage is likely
to be the Pevonedistat price optimal strategy for managing women presenting with ASC-US results.”
“BACKGROUND: Whether preoperative risk prediction improves with the use of more patient- and procedure-targeted models is unclear. We created a customized preoperative mortality risk prediction score for patients 80 years or older needing an emergency colectomy and compare it with existing, more generic risk assessment methods.\n\nSTUDY DESIGN: A targeted mortality prediction model was created using 2007 to 2008 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data and was validated using 2005 to 2006 data. We constructed a scoring system from the significant predictors identified. The model fit of our targeted score was compared with the American Society of Anesthesiologist’s (ASA) score, the Surgical Risk Scale, and the ACS Colorectal Surgery Risk Calculator.\n\nRESULTS: Analyses identified 1,358 and 372 emergency colectomies in the training and validation samples, respectively. Our targeted risk prediction score had a goodness-of-fit p value greater than 0.05 (indicating a good fit) and a c-statistic of 0.77, which represents a significantly better fit compared with the ASA score, the Surgical Risk Scale, and the ACS Colorectal Surgery Risk Calculator c-statistics (0.66, 0.66, and 0.71, respectively).