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October 20, 1999

Cost-effectiveness of Methods to Enhance Sensitivity of Papanicolaou Testing—Reply

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;282(15):1419-1420. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-15-jac90009

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.

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