James Nuovo

Preferences of Women Evaluating Risks of Tamoxifen (POWER) study of preferences for tamoxifen for breast cancer risk reduction.

The objective of this study was to understand the attitudes and preferences of risk‐eligible women regarding use of tamoxifen for breast cancer risk reduction.

Chemoprevention: drug pricing and mortality: the case of tamoxifen.

Tamoxifen is a prototypic cancer chemopreventive agent, yet clinical trials have not evaluated its effect on mortality or the impact of drug pricing on its cost‐effectiveness.

Cost-effectiveness Analysis Of Five Different Antibiotic Regimens For The Treatment Of Uncomplicated Chlamydia Trachomatis Cervicitis

Background: The new Centers for Disease Control and Prevention treatment guidelines for Chlamydia trachomatis include two recently available drugs, azithromycin and ofloxacin. The best choice for initial therapy remains controversial. Objectives: We wanted to perform a cost-effectiveness analysis of five different antibiotic regimens for the treatment of uncomplicated Chlamydia trachomatis cervicitis. Methods: Using information gathered from a MEDLINE search of the English language literature from 1966 to 1994, employing the key words “cervicitis,” “C. trachomatis,” “erythromycin,” “tetracycline,” “doxycycline,” “ofloxacin,” and “azithromycin,” we developed a decision analysis model specific for a nonpregnant woman with uncomplicated Chlamydia trachomatis cervicitis. Options in this model included an initially cured infection, a failed initial cure resulting in persistent cervicitis, or pelvic inflammatory disease treated either on an inpatient or outpatient basis. Probability estimates for each option were derived from previously published reports. A cost-effectiveness analysis was performed for three end points: cost per cure with initial therapy, cost per case of pelvic inflammatory disease averted, and cost per hospitalization averted. Sensitivity analyses were done by varying the cure rates for each antibiotic and the complication rates for failed therapy. The costs incurred for treatment were also varied. Results: Using the high estimate for initial cure rates, doxycycline and tetracycline were the most cost-effective agents. Azithromycin was the next most cost-effective agent, followed by ofloxacin and erythromycin. To achieve an equivalent final cost, the probability of initial cure with azithromycin must exceed that of doxycycline by 3 percentage points. As the cost of azithromycin decreases, the difference in initial cure rates between the two drugs to achieve an equivalent final cost becomes smaller. Conclusions: Doxycycline remains the drug of choice in the treatment of Chlamydia trachomatis cervicitis. The results favor the use of azithromycin rather than doxycycline when there is concern for compliance to the standard doxycycline regimen. A lower cost for azithromycin could favor its use as the drug of choice.

Detection of high-grade cervical dysplasia: impact of age and Bethesda system terminology.

Pap smear, colposcopy, and biopsy results were collected from 1988–1993 at a group of family planning clinics. Positive predictive values and likelihood ratios were calculated for diagnosis of high‐grade lesions based on age and Pap smear results. One thousand and forty‐seven colposcopies were logged; 771 had a biopsy or endocervical curettage. Seventy‐nine (10%) were high‐grade lesions. If only human papillomavirus (HPV) was reported on the Pap smear, the likelihood of a high‐grade biopsy was lowest (positive predictive value, 4.5%; likelihood ratio, 0.4). Women under age 25 were less likely to have high‐grade biopsies (positive predictive value, 7.3%; likelihood ratio 0.7). Repeat Pap smears for atypical cells of undetermined significance (ASCUS) and low grade squamous intra‐epithelial lesion (LGSIL) showing only HPV in women under age 30 would have reduced the immediate colposcopy rate by 60% and delayed diagnosis of 23% of high‐grade lesions. Consideration of patient age and whether HPV is the only Pap smear finding may reduce referral for immediate colposcopy. Diagn. Cytopathol. 1997;17:321–325.

A higher level of human papillomavirus 16 DNA was associated with an increased risk for cervical carcinoma in situ

P a r t i c i p a n t s Women who were < 50 years of age at entry, were born in Sweden, and had a normal first cervical smear and smears that contained genomic DNA as measured by β-actin. The case group consisted of 478 women (2081 smears). 5 women in the control group were matched to each woman with CIS by date of entry to the cohort, age, and time of first smear. Women in the control group had to be alive without developing CIS or invasive cervical cancer or having a hysterectomy before the date of diagnosis for their matched case; when only 1 smear was available for a woman randomly selected from the original pool of women in the control group, a second matched woman from the control group was randomly selected (n = 608 [478 first controls and 130 second controls], 1754 smears). A s s e s s m e n t o f r i s k f a c t o r s The level of HPV-16 DNA was estimated by using quantitative polymerase chain reaction (5′ exonuclease [Taqman] method). To adjust for different levels of genomic DNA, a nuclear gene (β-actin) was assessed.

Review: newer technologies improve sensitivity in detecting uterine cervical lesions but at a substantially increased cost

Study selection Studies were selected if cervical cytology was evaluated as a screening test, the reference standard was histology or colposcopy, and sensitivity and specificity (or relative true positive and false positive rates) could be calculated. Cytology was an acceptable reference standard if the studies also included an independent panel of cytology specialists to arrive at a consensus diagnosis and a 2 arm prospective study design was used. The cost analysis considered the cost of all medical services provided for screening, diagnosis, and treatment.