Proposed structure of economic evaluation (decision-analytic) Table 5: Summary of PICO to define research question that assessment will investigate Patients Intervention Comparator Outcomes to be assessed Healthcare resources to be considered Cell enrichment LBC Conventional cytology Health outcomes: See 4 presenting for Overall survival cervical cytology Incidence of cervical cancer screening Proposed secondary Proposed secondary Cervical cancer-specific mortality between 18-69 comparison: comparison: cell years Automated versus filtration LBC Diagnostic outcomes: Detection manual reading of cell of HSIL, and LSIL, CIN enrichment LBC lesions measured as: Test yield Sensitivity and specificity Positive and negative predictive value,True postive:false positive Incremental rate of true positive Unsatisfactory rates Proportion of CIN lesions detected in each cytological category Change in management Impact of screening on clinical management Patient outcomes: Quality of life, patient preference, satisfaction, anxiety, patient compliance, safety, adverse events What is the safety, effectiveness and cost effectiveness of cell enrichment liquid-based cytology using manual reading of slides compared with manual reading of conventionally prepared Pap smear cytology? What is the safety, effectiveness and cost effectiveness of cell enrichment liquid cytology using automated image analysis systems compared with manual reading of conventionally prepared Pap smear cytology? What is the safety, effectiveness and cost effectiveness of cell enrichment liquid based cytology compared with cell filtration liquid based cell cytology? To what extent, if at all, do these comparisons vary according to whether either method of cytology is assessed using manual reading or automated image analysis systems? The economic model used in the 2009 MSAC review of LBC was conducted using a set of linked models to simulate (i) sexual behaviour and HPV transmission in Australia; (ii) the natural history of cervical intraepithelial neoplasia (CIN) and invasive cervical cancer; and (iii) screening, diagnosis and treatment according to practice in Australia (see Figure 2). These models were based on previously published work (Canfell et al 2004; Smith et al 2008) and on a screening model developed for the NZ National Screening Unit (Canfell et al 2008) and was used as a template to assist in developing this consultation decision analytic protocol for cell enrichment liquid based cytology. An erratum which recalculated the model over a lifetime beginning at 18 years of age was subsequently published at: ().
Proposed structure of economic evaluation (decision-analytic) Table 5: Summary of PICO to define research question that assessment will investigate Patients Intervention Comparator Outcomes to be assessed Healthcare resources to be considered presenting for cervical cytology screening between 18-69 years Cell enrichment LBC Proposed secondary comparison: Automated versus manual reading of cell enrichment LBC Conventional cytology Proposed secondary comparison: cell filtration LBC Health outcomes: Overall survival Incidence of cervical cancer Cervical cancer-specific mortality Diagnostic outcomes: Detection of HSIL, and LSIL, CIN lesions measured as: Test yield Sensitivity and specificity Positive and negative predictive value,True postive:false positive Incremental rate of true positive Unsatisfactory rates Proportion of CIN lesions detected in each cytological category Change in management Impact of screening on clinical management Patient outcomes: Quality of life, patient preference, satisfaction, anxiety, patient compliance, safety, adverse events See 4 What is the safety, effectiveness and cost effectiveness of cell enrichment liquid-based cytology using manual reading of slides compared with manual reading of conventionally prepared Pap smear cytology? What is the safety, effectiveness and cost effectiveness of cell enrichment liquid cytology using automated image analysis systems compared with manual reading of conventionally prepared Pap smear cytology? What is the safety, effectiveness and cost effectiveness of cell enrichment liquid based cytology compared with cell filtration liquid based cell cytology? To what extent, if at all, do these comparisons vary according to whether either method of cytology is assessed using manual reading or automated image analysis systems? The economic model used in the 2009 MSAC review of LBC was conducted using a set of linked models to simulate (i) sexual behaviour and HPV transmission in Australia; (ii) the natural history of cervical intraepithelial neoplasia (CIN) and invasive cervical cancer; and (iii) screening, diagnosis and treatment according to practice in Australia (see Figure 2). These models were based on previously published work (Canfell et al 2004; Smith et al 2008) and on a screening model developed for the NZ National Screening Unit (Canfell et al 2008) and was used as a template to assist in developing this consultation decision analytic protocol for cell enrichment liquid based cytology. An erratum which recalculated the model over a lifetime beginning at 18 years of age was subsequently published at: ().
1157-LBC-Final-DAP-AccessibleFINAL.docx