Jane J Kim

University of California, San Diego, San Diego, California, United States

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Publications (98)758.69 Total impact

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    ABSTRACT: Decision-analytic models are increasingly used to inform health policy decisions. These models synthesize available data on disease burden and intervention effectiveness to project estimates of the long-term consequences of care, which are often absent when clinical or policy decisions must be made. While models have been influential in informing US cancer screening guidelines under ideal conditions, incorporating detailed data on real-world screening practice has been limited given the complexity of screening processes and behaviors throughout diverse health delivery systems in the United States. We describe the synergies that exist between decision-analytic models and health care utilization data that are increasingly accessible through research networks that assemble data from the growing number of electronic medical record systems. In particular, we present opportunities to enrich cancer screening models by grounding analyses in real-world data with the goals of projecting the harms and benefits of current screening practices, evaluating the value of existing and new technologies, and identifying the weakest links in the cancer screening process where efforts for improvement may be most productively focused. We highlight the example of the National Cancer Institute–funded consortium Population-based Research Optimizing Screening through Personalized Regimens (PROSPR), a collaboration to harmonize and analyze screening process and outcomes data on breast, colorectal, and cervical cancers across seven research centers. The pairing of models with such data can create more robust models to not only better inform policy but also inform health care systems about best approaches to improve the provision of cancer screening in the United States.
    No preview · Article · Feb 2016 · JNCI Journal of the National Cancer Institute
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    ABSTRACT: Objective To measure the benefits to household caregivers of a psychotherapeutic intervention for adolescents and young adults living in a war-affected area. Methods Between July 2012 and July 2013, we carried out a randomized controlled trial of the Youth Readiness Intervention – a cognitive–behavioural intervention for war-affected young people who exhibit depressive and anxiety symptoms and conduct problems – in Freetown, Sierra Leone. Overall, 436 participants aged 15–24 years were randomized to receive the intervention (n = 222) or care as usual (n = 214). Household caregivers for the participants in the intervention arm (n = 101) or control arm (n = 103) were interviewed during a baseline survey and again, if available (n = 155), 12 weeks later in a follow-up survey. We used a burden assessment scale to evaluate the burden of care placed on caregivers in terms of emotional distress and functional impairment. The caregivers’ mental health – i.e. internalizing, externalizing and prosocial behaviour – was evaluated using the Oxford Measure of Psychosocial Adjustment. Difference-in-differences multiple regression analyses were used, within an intention-to-treat framework, to estimate the treatment effects. Findings Compared with the caregivers of participants of the control group, the caregivers of participants of the intervention group reported greater reductions in emotional distress (scale difference: 0.252; 95% confidence interval, CI: 0.026–0.4782) and greater improvements in prosocial behaviour (scale difference: 0.249; 95% CI: 0.012–0.486) between the two surveys. Conclusion A psychotherapeutic intervention for war-affected young people can improve the mental health of their caregivers.
    Preview · Article · Dec 2015 · Bulletin of the World Health Organisation
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    ABSTRACT: Aging is associated with a decline in multiple aspects of cognitive function, with spatial cognition being particularly sensitive to age-related decline. Environmental stressors, such as high-fat diet (HFD) exposure, that produce a diabetic phenotype and metabolic dysfunction may indirectly lead to exacerbated brain aging and promote the development of cognitive deficits. The present work investigated whether exposure to HFD exacerbates age-related cognitive deficits in adult versus aged mice. Adult (5 months old) and aged (15 months old) mice were exposed to control diet or HFD for three months prior to, and throughout, behavioral testing. Anxiety-like behavior in the light-dark box test, discrimination learning and memory in the novel object/place recognition tests, and spatial learning and memory in the Barnes maze test were assessed. HFD resulted in significant gains in body weight and fat mass content with adult mice gaining significantly more weight and adipose tissue due to HFD than aged mice. Weight gain was attributed to food calories sourced from fat, but not total calorie intake. HFD increased fasting insulin levels in all mice, but adult mice showed a greater increase relative to aged mice. Behaviorally, HFD increased anxiety-like behavior in adult but not aged mice without significantly affecting spatial cognition. In contrast, aged mice fed either control or HFD diet displayed deficits in novel place discrimination and spatial learning. Our results suggest that adult mice are more susceptible to the physiological and anxiety-like effects of HFD consumption than aged mice, while aged mice displayed deficits in spatial cognition regardless of dietary influence. We conclude that although HFD induces systemic metabolic dysfunction in both adult and aged mice, overall cognitive function was not adversely affected under the current experimental conditions.
    Full-text · Article · Oct 2015 · PLoS ONE
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    ABSTRACT: Background: Studies suggest that cervical cancer screening practice in the United States is inefficient. The cost and health implications of nonadherence in the screening process compared with recommended guidelines are uncertain. Objective: To estimate the benefits, costs, and cost-effectiveness of current cervical cancer screening practice and assess the value of screening improvements. Design: Model-based cost-effectiveness analysis. Data sources: New Mexico HPV Pap Registry; medical literature. Target population: Cohort of women eligible for routine screening. Time horizon: Lifetime. Perspective: Societal. Intervention: Current cervical cancer screening practice; improved adherence to guidelines-based screening interval, triage testing, diagnostic referrals, and precancer treatment referrals. Outcome measures: Reductions in lifetime cervical cancer risk, quality-adjusted life-years (QALYs), lifetime costs, incremental cost-effectiveness ratios, and incremental net monetary benefits (INMBs). Results of base-case analysis: Current screening practice was associated with lower health benefit and was not cost-effective relative to guidelines-based strategies. Improvements in the screening process were associated with higher QALYs and small changes in costs. Perfect adherence to screening every 3 years with cytologic testing and adherence to colposcopy/biopsy referrals were associated with the highest INMBs ($759 and $741, respectively, at a willingness-to-pay threshold of $100 000 per QALY gained); together, the INMB increased to $1645. Results of sensitivity analysis: Current screening practice was inefficient in 100% of simulations. The rank ordering of screening improvements according to INMBs was stable over a range of screening inputs and willingness-to-pay thresholds. Limitation: The effect of human papillomavirus vaccination was not considered. Conclusions: The added health benefit of improving adherence to guidelines, especially the 3-year interval for cytologic screening and diagnostic follow-up, may justify additional investments in interventions to improve U.S. cervical cancer screening practice. Primary funding source: U.S. National Cancer Institute.
    No preview · Article · Sep 2015 · Annals of internal medicine
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    ABSTRACT: Background: One billion children live in war-affected regions of the world. We conducted the first cost-effectiveness analysis of an intervention for war-affected youth in sub-Saharan Africa, as well as a broader cost analysis. Methods: The Youth Readiness Intervention (YRI) is a behavioural treatment for reducing functional impairment associated with psychological distress among war-affected young persons. A randomized controlled trial was conducted in Freetown, Sierra Leone, from July 2012 to July 2013. Participants (n = 436, aged 15-24) were randomized to YRI (n = 222) or care as usual (n = 214). Functional impairment was indexed by the World Health Organization Disability Assessment Scale; scores were converted to quality-adjusted life years (QALYs). An 'ingredients approach' estimated financial and economic costs, assuming a societal perspective. Incremental cost-effectiveness ratios (ICERs) were also expressed in terms of gains across dimensions of mental health and schooling. Secondary analyses explored whether intervention effects were largest among those worst-off (upper quartile) at baseline. Results: Retention at 6-month follow-up was 85% (n = 371). The estimated economic cost of the intervention was $104 per participant. Functional impairment was lower among YRI recipients, compared with controls, following the intervention but not at 6-month follow-up, and yielded an ICER of $7260 per QALY gained. At 8-month follow-up, teachers' interviews indicated that YRI recipients observed higher school enrolment [P < 0.001, odds ratio (OR) 8.9], denoting a cost of $431 per additional school year gained, as well as better school attendance (P = 0.007, OR 34.9) and performance (P = 0.03, effect size = -1.31). Secondary analyses indicated that the intervention was cost-effective among those worst-off at baseline, yielding an ICER of $3564 per QALY gained. Conclusions: The YRI is not cost-effective at a willingness-to-pay threshold of three times average gross domestic product per capita. However, results indicate that the YRI translated into a range of benefits, such as improved school enrolment, not captured by cost-effectiveness analysis. We also outline areas for modification to improve cost-effectiveness in future trials. Trial registration: clinicaltrials.gov Identifier: RPCGA-YRI-21003.
    No preview · Article · Sep 2015 · Health Policy and Planning
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    ABSTRACT: Changes to national guidelines for breast and cervical cancer screening have created confusion and controversy for women and their primary care providers. To characterize women's primary health care provider attitudes towards screening and changes in practice in response to recent revisions in guidelines for breast and cervical cancer screening. In 2014, we distributed a confidential web and mail survey to 668 women's health care providers affiliated with the four clinical care networks participating in the three PROSPR (Population-based Research Optimizing Screening through Personalized Regimens) consortium breast cancer research centers (385 respondents; response rate 57.6 %). We assessed self-reported attitudes toward breast and cervical cancer screening, as well as practice changes in response to the most recent revisions of the U.S. Preventive Services Task Force (USPSTF) recommendations. The majority of providers believed that mammography screening was effective for reducing cancer mortality among women ages 40-74 years, and that Papanicolaou (Pap) testing was very effective for women ages 21-64 years. While the USPSTF breast and cervical cancer screening recommendations were widely perceived by the respondents as influential, 75.7 and 41.2 % of providers (for mammography and cervical cancer screening, respectively) reported screening practices in excess of those recommended by USPSTF. Provider-reported barriers to concordance with guideline recommendations included: patient concerns (74 and 36 % for breast and cervical, respectively), provider disagreement with the recommendations (50 and 14 %), health system measurement of a provider's screening practices that use conflicting measurement criteria (40 and 21 %), concern about malpractice risk (33 and 11 %), and lack of time to discuss the benefits and harms with their patients (17 and 8 %). Primary care providers do not consistently follow recent USPSTF breast and cervical cancer screening recommendations, despite noting that these guidelines are influential.
    Full-text · Article · Jul 2015 · Journal of General Internal Medicine
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    ABSTRACT: Docosahexaenoic acid (DHA 22:6n-3) and salicylate (acetylsalicylic acid) are both known to exert anti-inflammatory effects. This study investigated the effects of a novel bifunctional drug compound consisting of DHA and salicylate linked together by a small molecule that is stable in plasma but hydrolyzed in the cytoplasm. The components of the bifunctional compound acted synergistically to reduce inflammation mediated via nuclear factor kappa B (NFκB) in cultured macrophages. Notably, oral administration of the bifunctional compound acted in two distinct ways to mitigate hyperglycemia in high-fat diet (HFD)-induced insulin resistance. In mice with diet-induced obesity, the compound lowered blood glucose by reducing hepatic insulin resistance. It also had an immediate glucose-lowering effect that was secondary to enhanced glucagon-like peptide-1 (GLP-1) secretion and abrogated by the administration of Exendin(9-39), a GLP-1 receptor antagonist. These results suggest that the bifunctional compound could be an effective treatment for individuals with type 2 diabetes and insulin resistance. This strategy could also be employed in other disease conditions characterized by chronic inflammation. Copyright © 2015, American Journal of Physiology - Endocrinology and Metabolism.
    Full-text · Article · Jun 2015 · AJP Endocrinology and Metabolism
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    ABSTRACT: General frameworks of the cancer screening process are available, but none directly compare the process in detail across different organ sites. This limits the ability of medical and public health professionals to develop and evaluate coordinated screening programs that apply resources and population management strategies available for one cancer site to other sites. We present a trans-organ conceptual model that incorporates a single screening episode for breast, cervical, and colorectal cancers into a unified framework based on clinical guidelines and protocols; the model concepts could be expanded to other organ sites. The model covers four types of care in the screening process: risk assessment, detection, diagnosis, and treatment. Interfaces between different provider teams (eg, primary care and specialty care), including communication and transfer of responsibility, may occur when transitioning between types of care. Our model highlights across each organ site similarities and differences in steps, interfaces, and transitions in the screening process and documents the conclusion of a screening episode. This model was developed within the National Cancer Institute-funded consortium Population-based Research Optimizing Screening through Personalized Regimens (PROSPR). PROSPR aims to optimize the screening process for breast, cervical, and colorectal cancer and includes seven research centers and a statistical coordinating center. Given current health care reform initiatives in the United States, this conceptual model can facilitate the development of comprehensive quality metrics for cancer screening and promote trans-organ comparative cancer screening research. PROSPR findings will support the design of interventions that improve screening outcomes across multiple cancer sites. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.
    No preview · Article · Jun 2015 · Journal of the National Cancer Institute
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    ABSTRACT: World Health Organization guidelines recommend that cervical cancer screening programs should prioritize screening coverage in women aged 30 to 49 years. Decisions about target ages and screening frequency depend upon local burden of disease, costs, and capacity. We used cost and test performance data from the START-UP demonstration projects in India, Nicaragua, and Uganda to evaluate the cost-effectiveness of screening at various start ages, intervals, and frequencies. We calibrated a mathematical simulation model of cervical carcinogenesis to each country and compared screening with careHPV (cervical and vaginal sampling), visual inspection with acetic acid (VIA), and cytology between the ages of 25 and 50 years, at frequencies of once to three times in a lifetime, at 5- and 10-year intervals. Screening with careHPV (cervical sampling) was the most effective and cost-effective strategy in all settings; careHPV (vaginal sampling) was only slightly less effective. The most critical ages for screening are between ages 30 and 45 years. Within this age range, screening at certain ages may be relatively more cost-effective, but cancer risk reductions are similar for a given screening test and interval. Screening three times between 30 and 45 years was very cost-effective and reduced cancer risk by ~50%.
    Preview · Article · Jun 2015
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    ABSTRACT: As cervical cancer screening programs are implemented in low-resource settings, protocols are needed to maximize health benefits under operational constraints. Our objective was to develop a framework for examining health and economic tradeoffs between screening test sensitivity, population coverage, and follow-up of screen-positive women, to help decision makers identify where program investments yield the greatest value. As an illustrative example, we used an individual-based Monte Carlo simulation model of the natural history of human papillomavirus (HPV) and cervical cancer calibrated to epidemiologic data from Uganda. We assumed once in a lifetime screening at age 35 with two-visit HPV DNA testing or one-visit visual inspection with acetic acid (VIA). We assessed the health and economic tradeoffs that arise between 1) test sensitivity and screening coverage; 2) test sensitivity and loss to follow-up (LTFU) of screen-positive women; and 3) test sensitivity, screening coverage, and LTFU simultaneously. The decline in health benefits associated with sacrificing HPV DNA test sensitivity by 20% (e.g., shifting from provider- to self-collection of specimens) could be offset by gains in coverage if coverage increased by at least 20%. When LTFU was 10%, two-visit HPV DNA testing with 80-90% sensitivity was more effective and more cost-effective than one-visit VIA with 40% sensitivity, and yielded greater health benefits than VIA even as VIA sensitivity increased to 60% and HPV test sensitivity declined to 70%. As LTFU increased, two-visit HPV DNA testing became more costly and less effective than one-visit VIA. Setting-specific data on achievable test sensitivity, coverage, follow-up rates, and programmatic costs are needed to guide programmatic decision making for cervical cancer screening. This article is protected by copyright. All rights reserved. © 2015 UICC.
    No preview · Article · May 2015 · International Journal of Cancer
  • Jane J Kim · Philip E Castle

    No preview · Article · Apr 2015 · Journal of Lower Genital Tract Disease
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    ABSTRACT: Cervical cancer screening and existing health insurance schemes in China fall short of reaching women with prevention and treatment services, especially in rural areas where the disease burden is greatest. We conducted an extended cost-effectiveness analysis (ECEA) to evaluate public financing of HPV vaccination to prevent cervical cancer, adding new dimensions to conventional cost-effectiveness analysis through an explicit inclusion of equity and impact on financial risk protection. We synthesized available epidemiological, clinical, and economic data from China using an individual-based Monte Carlo simulation model of cervical cancer to estimate the distribution of deaths averted by income quintile, comparing vaccination plus screening against current practice. We also estimated reductions in cervical cancer incidence, net costs to the government (HPV vaccination costs minus cervical cancer treatment costs averted), and patient cost savings, as well as the incremental government health care costs per death averted. HPV vaccination is cost-effective across all income groups when the cost is less than US $50 per vaccinated girl. Compared to screening alone, adding preadolescent HPV vaccination followed by cervical cancer screening in adulthood could reduce cancer by 44 percent across all income groups, while providing relatively higher financial protection to the poorest women. The absolute numbers of cervical cancer deaths averted and the financial risk protection from HPV vaccination are highest among women in the lowest quintile; women in the bottom income quintiles received higher benefits than those in the upper wealth quintiles. Patient cost savings represent a large proportion of poor women's average per capita income, reaching 60 percent among women in the bottom income quintile and declining to 15 percent among women in the wealthiest quintile. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
    Full-text · Article · Mar 2015 · Vaccine
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    ABSTRACT: Cervical cancer is the leading cause of cancer death among women in El Salvador. Utilizing data from the Cervical Cancer Prevention in El Salvador (CAPE) demonstration project, we assessed the health and economic impact of HPV-based screening and two different algorithms for the management of women who test HPV-positive, relative to existing Pap-based screening. We calibrated a mathematical model of cervical cancer to epidemiologic data from El Salvador and compared three screening algorithms for women aged 30 to 65 years: 1) HPV screening every 5 years followed by referral to colposcopy for HPV-positive women (Colposcopy Management [CM]); 2) HPV screening every 5 years followed by treatment with cryotherapy for eligible HPV-positive women (Screen and Treat [ST]); and 3) Pap screening every 2 years followed by referral to colposcopy for Pap-positive women (Pap). Potential harms and complications associated with overtreatment were not assessed. Under base case assumptions of 65% screening coverage, HPV-based screening was more effective than Pap, reducing cancer risk by approximately 60% (Pap: 50%). ST was the least costly strategy, and cost $2,040 per year of life saved. ST remained the most attractive strategy as visit compliance, costs, coverage, and test performance were varied. We conclude that a screen-and-treat algorithm within an HPV-based screening program is very cost-effective in El Salvador, with a cost-effectiveness ratio below per capita GDP. This article is protected by copyright. All rights reserved.
    No preview · Article · Jan 2015 · International Journal of Cancer
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    ABSTRACT: Purpose: Standardized screening protocols for anal cancer do not yet exist despite the growing evidence that this human papillomavirus (HPV)-related cancer is preceded by premalignant stages, which if detected and removed, may prevent progression to cancer. Men who have sex with men (MSM) who are human immunodeficiency virus (HIV)-infected are among those at highest risk for anal cancer development. In order to inform policy recommendations in the United States, we estimated the health benefits and resource trade-offs associated with alternative primary anal cancer screening strategies for HIV-infected MSM. Method: We developed and calibrated a natural history microsimulation model that reflects the most recent understanding of anal carcinogenesis, accounting for interactions between HPV type-specific infections, CD4 lymphocyte strata, and anti-retroviral treatment (ART) status. Relevant strategies involved cytology-based screening, which varied by screening interval (i.e., every 1-3 years) and age at which men initiate screening (i.e., 30 vs. 40 years). Triage of abnormal results involved high-resolution anoscopy. Primary outcomes included discounted life expectancy (3% per year), cancer risk reduction and resource use (number of anoscopies performed). We calculated the incremental harm-benefit ratio (IHBR) in terms of the additional number of anoscopies required per year of life saved (YLS) for each strategy compared with the next most harmful strategy. Sensitivity analyses were conducted on test characteristics, and parameter uncertainty for progression to invasive cancer. Results: Compared with no screening, the least intensive strategy is projected to reduce cancer risk by 24%, while the most intensive strategy may reduce cancer risk by 66% among HIV-infected MSM. All strategies that initiated screening at age 40 were dominated by strategies that started at age 30. For those strategies on the harm-benefit frontier, triennial cytology-based screening required an additional 7.2 anoscopies per YLS compared with no screening, while the most intensive screening strategy (annual) required an additional 40.3 anoscopies per YLS, compared with biennial screening. The rank-order of strategies was preserved when we assumed a less sensitive anal cytology test. Conclusion: For HIV-infected MSM, the most efficient anal cancer screening strategies involve starting at age 30; however, the optimal screening interval is unclear, as more intensive strategies require explicit trade-offs between the harms and benefits, and depend on capacity constraints and society's willingness-to-pay for life-years and other health benefits.
    No preview · Conference Paper · Oct 2014
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    Emily A Burger · Jane J Kim
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    ABSTRACT: Failures in cervical cancer screening include non-participation, under-screening, and loss-to-follow up of abnormal results. We estimated the long-term health benefits from and maximum investments in interventions targeted to improving compliance to guidelines while remaining cost-effective. We employed a mathematical model empirically calibrated to simulate the natural history of cervical cancer in Norway. A baseline scenario reflecting current practice using cytology-based screening was compared to scenarios that target different sources of non-compliance: 1) failure to follow-up women with abnormal results, 2) screening less frequently than recommended (i.e., under-screening), and 3) absence of screening. A secondary analysis included human papillomavirus (HPV)-based screening as the primary test. Model outcomes included reductions in lifetime cancer risk and incremental net monetary benefit (INMB) resulting from improvements with compliance. Compared to the status quo, improving all sources of non-compliance leads to important health gains and produced positive INMBs across a range of developed-country willingness-to-pay thresholds. For example, a 2% increase in compliance could reduce lifetime cancer risk by 1-3%, depending on the targeted source of non-compliance and primary screening method. Assuming a willingness-to-pay threshold of $83,000 per year of life saved and cytology-based screening, interventions that increase follow-up of abnormal results yielded the highest INMB per 2% increase in coverage ($19 ($10-21)). With HPV-based screening, recruiting non-screeners resulted in the largest INMB ($23 ($18-32)). Considerable funds could be allocated towards policies that improve compliance with screening under the current cytology-based program or towards adoption of primary HPV-based screening while remaining cost-effective. © 2014 Wiley Periodicals, Inc.
    Preview · Article · Oct 2014 · International Journal of Cancer
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    Sorapop Kiatpongsan · Jane J Kim
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    ABSTRACT: Background: Current prophylactic vaccines against human papillomavirus (HPV) target two of the most oncogenic types, HPV-16 and -18, which contribute to roughly 70% of cervical cancers worldwide. Second-generation HPV vaccines include a 9-valent vaccine, which targets five additional oncogenic HPV types (i.e., 31, 33, 45, 52, and 58) that contribute to another 15-30% of cervical cancer cases. The objective of this study was to determine a range of vaccine costs for which the 9-valent vaccine would be cost-effective in comparison to the current vaccines in two less developed countries (i.e., Kenya and Uganda).
    Preview · Article · Sep 2014 · PLoS ONE
  • Jane J Kim

    No preview · Article · Aug 2014 · JNCI Journal of the National Cancer Institute
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    ABSTRACT: Mathematical models of cervical cancer have been widely used to evaluate the comparative effectiveness and cost-effectiveness of preventive strategies. Major advances in the understanding of cervical carcinogenesis motivate the creation of a new disease paradigm in such models. To keep pace with the most recent evidence, we updated a previously developed microsimulation model of human papillomavirus (HPV) infection and cervical cancer to reflect 1) a shift towards health states based on HPV rather than poorly reproducible histological diagnoses and 2) HPV clearance and progression to precancer as a function of infection duration and genotype, as derived from the control arm of the Costa Rica Vaccine Trial (2004-2010). The model was calibrated leveraging empirical data from the New Mexico Surveillance, Epidemiology, and End Results Registry (1980-1999) and a state-of-the-art cervical cancer screening registry in New Mexico (2007-2009). The calibrated model had good correspondence with data on genotype- and age-specific HPV prevalence, genotype frequency in precancer and cancer, and age-specific cancer incidence. We present this model in response to a call for new natural history models of cervical cancer intended for decision analysis and economic evaluation at a time when global cervical cancer prevention policy continues to evolve and evidence of the long-term health effects of cervical interventions remains critical.
    Full-text · Article · Jul 2014 · American Journal of Epidemiology
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    ABSTRACT: Background: Human papillomavirus (HPV) vaccines are ideally administered before HPV exposure; therefore, catch-up programs for girls past adolescence have not been readily funded. We evaluated the benefits and cost-effectiveness of a delayed, 1-year female catch-up vaccination program in Norway. Methods: We calibrated a dynamic HPV transmission model to Norwegian data and projected the costs and benefits associated with 8 HPV-related conditions while varying the upper vaccination age limit to 20, 22, 24, or 26 years. We explored the impact of vaccine protection in women with prior vaccine-targeted HPV infections, vaccine cost, coverage, and natural- and vaccine-induced immunity. Results: The incremental benefits and cost-effectiveness decreased as the upper age limit for catch-up increased. Assuming a vaccine cost of $150/dose, vaccination up to age 20 years remained below Norway's willingness-to-pay threshold (approximately $83 000/quality-adjusted life year gained); extension to age 22 years was cost-effective at a lower cost per dose ($50-$75). At high levels of vaccine protection in women with prior HPV exposure, vaccinating up to age 26 years was cost-effective. Results were stable with lower coverage. Conclusions: HPV vaccination catch-up programs, 5 years after routine implementation, may be warranted; however, even at low vaccine cost per dose, the cost-effectiveness of vaccinating beyond age 22 years remains uncertain.
    Full-text · Article · Jul 2014 · The Journal of Infectious Diseases
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    ABSTRACT: Increasingly, countries have introduced female vaccination against human papillomavirus (HPV), causally linked to several cancers and genital warts, but few have recommended vaccination of boys. Declining vaccine prices and strong evidence of vaccine impact on reducing HPV-related conditions in both women and men prompt countries to reevaluate whether HPV vaccination of boys is warranted. A previously-published dynamic model of HPV transmission was empirically calibrated to Norway. Reductions in the incidence of HPV, including both direct and indirect benefits, were applied to a natural history model of cervical cancer, and to incidence-based models for other non-cervical HPV-related diseases. We calculated the health outcomes and costs of the different HPV-related conditions under a gender-neutral vaccination program compared to a female-only program. Vaccine price had a decisive impact on results. For example, assuming 71% coverage, high vaccine efficacy and a reasonable vaccine tender price of $75 per dose, we found vaccinating both girls and boys fell below a commonly cited cost-effectiveness threshold in Norway ($83,000/quality-adjusted life year (QALY) gained) when including vaccine benefit for all HPV-related diseases. However, at the current market price, including boys would not be considered 'good value for money.' For settings with a lower cost-effectiveness threshold ($30,000/QALY), it would not be considered cost-effective to expand the current program to include boys, unless the vaccine price was less than $36/dose. Increasing vaccination coverage to 90% among girls was more effective and less costly than the benefits achieved by vaccinating both genders with 71% coverage. At the anticipated tender price, expanding the HPV vaccination program to boys may be cost-effective and may warrant a change in the current female-only vaccination policy in Norway. However, increasing coverage in girls is uniformly more effective and cost-effective than expanding vaccination coverage to boys and should be considered a priority.
    Full-text · Article · Mar 2014 · PLoS ONE

Publication Stats

3k Citations
758.69 Total Impact Points

Institutions

  • 2009-2015
    • University of California, San Diego
      • • Department of Pediatrics
      • • Division of Endocrinology & Metabolism
      San Diego, California, United States
  • 2006-2015
    • Harvard University
      • Department of Health Policy and Management
      Cambridge, Massachusetts, United States
    • Duke University
      Durham, North Carolina, United States
  • 2004-2015
    • Harvard Medical School
      • Department of Medicine
      Boston, Massachusetts, United States
    • Oak Ridge Center For Risk Analysis
      オーク・リッジ, Tennessee, United States
  • 2002
    • Columbia University
      • Department of Medicine
      New York, New York, United States