Computer Networks 5th Edition A Systems Approach Free Pdf Ebook
Click Here ->>->>->> https://urluso.com/2tdzdv
In one of the first practical applications of CPGs to a high-risk population, Grover et al (2009) modeled the effects of increased screening intensity on the effectiveness of cervical cancer screening. Data from the Gynocancer Project Registry were used to estimate the relative risk of cervical cancer incidence for women who tested negative for invasive cervical cancer (ICC, squamous cell carcinomas and adenocarcinomas) each time they were screened. Screening history was divided into up to four consecutive annual test cycles. Effectiveness was measured cumulatively over five years. The authors evaluated the effect of screening intensity five times over the screening interval. They applied a 30% colposcopic referral rate and 2% ICC mortality rate. They found that a high annual ICC incidence in the most recent prior test cycle was associated with a five-year cumulative effectiveness in excess of 90% for all screening intensities. The authors concluded that "[i]f the U.S. Preventive Services Task Force guidelines call for monthly screening [...] the high-risk women who want to be screened monthly can be offered this option without limiting access to others".
A probabilistic analysis by Bolland et al (2009) calculated the cost-effectiveness of using the Pap smear and HPV test as combination screening tests. Combination screening was evaluated over a 10-year period when women aged 25 and over were screened with Pap tests at intervals of 20 years or less for 5 years and HPV tests at 3-year intervals with immediate cytologic follow-up of HPV-positives. The authors assumed that if a woman has at least 1 HPV DNA test after the first 3 years, then she will eventually receive a colposcopy after the fifth test. The authors used the Markov model to calculate the 10-year effective epidemiologically weighted lifetime costs and quality-adjusted life-years associated with these screening strategies. Cost-effectiveness analysis was not performed because the Pap test cost was not included in the model. The authors concluded that, in general, the Pap test was not a cost-effective initial screening tool, although after 5 years it provided longer effective lifetime periods compared to no screening. HPV testing did not eliminate the need for a Pap smear, and thus the initial screening cost was not saved. d2c66b5586