Question

1. (45 pts total) An article in JAMA by Mandelblatt et al (2002) compared the societal costs and benefits of human papillomavirus (HPV) testing, Pap testing, and their combination to screen for cervical cancer. The following table summarizes some of the results (low cost to high cost). Costs include screening and treatment costs, discounted over the individual’s expected lifetime.

Strategy	Cost ($)	QALYs Saved	Incremental Cost	Incremental QALY	Incremental CE ratio (ICER)
0. No screening	5,000	26.87	-	-	-
1. Pap every 3 years to age 75	6,825	27.02
2. HPV every 3 years to age 75	6,950	27.02
3. Pap every 2 years to age 75	7,275	27.04
4. Pap + HPV every 3 years to age 75	7,400	27.04
5. HPV every 2 years to age 75	7,450	27.04
6. Pap + HPV every 2 years to age 75	7,925	27.05

1. (6 pts.) Identify all dominated screening strategies. Recall a strategy is dominated if it costs more than an equally or more effective strategy, or it is less effective than another strategy that costs the same or less. List the strategy number(s) here.

2. (36 pts.) Fill in the table above. Calculate the incremental cost, incremental QALYs, and ICERs for all economically rational strategies (relative to strategy 0, no screening).

3. (3 pts.) The local health district has asked your opinion on the “best” strategy from a public health perspective. What do you tell them?

Answer 1