Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor
In Reply: As Dr Leidy and colleagues and Dr
Sedlacek state, we believe that quality-adjusted life-years constitute the
preferred measure of outcomes. We reported outcomes in life-years to preserve
comparability to the major published cost-effectiveness analyses of cervical
cancer screening. Furthermore, reliable estimates of the effects of the technologies
on quality of life are unavailable. A clinical trial comparing the technologies
that measured changes in quality of life and life expectancy might be the
best way to assess cost-effectiveness. It would be surprising, however, if
such a trial produced findings substantially different from those we reported.
In preliminary analyses, we calculated the effects of the new technologies
on quality-adjusted life-years, using a wide range of values for quality of
life. The results were similar to those reported in the article.
Brown AD, Garber AM. Cost-effectiveness of Methods to Enhance Sensitivity of Papanicolaou Testing—Reply. JAMA. 1999;282(15):1419-1420. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-15-jac90009