MDM Policy and Practice最新文献

{"title":"Resistance to a Novel Clinical Trial Design for Multicancer Detection Tests: Experimental Investigation of Ambiguity Aversion.","authors":"Jacob A Rohde, Jackelyn B Payne, Richard P Moser, William M P Klein, Philip E Castle, Paul K J Han","doi":"10.1177/23814683261477027","DOIUrl":"10.1177/23814683261477027","url":null,"abstract":"<p><strong>Background: </strong>Randomized controlled trials (RCTs) are needed to evaluate multicancer detection (MCD) tests. A novel \"intended-effect\" RCT design in which control group participants receive MCD testing but results remain undisclosed can increase statistical efficiency. Prospective participants may find this design unacceptable due to ambiguity aversion introduced by the existence of undisclosed but theoretically knowable test results. We evaluated this effect and tested if reducing ambiguity by ensuring the unknowability of test results mitigates this bias.</p><p><strong>Methods: </strong>US adults aged 45 to 70 y (<i>N</i> = 1,576) were randomized to read about 1 of 4 RCT designs evaluating MCD testing: 1) RCT with a conventional control group (no testing), 2) RCT with a standard intended-effect control group (ie, control gets testing but not the results), 3) modified intended-effect RCT emphasizing disclosure safeguards to ensure the unknowability of control group test results to participants and researchers, and 4) modified intended-effect RCT with time-delayed testing on control group blood samples after trial completion. Outcomes were study interest (5-point scale, with higher values indicating more interest) and intention to participate (yes/no). Analyses of variance, chi-square tests, and regression-based analyses examined the main effects and potential mediating roles of the perceived net benefit of participating in the study and trust in study researchers.</p><p><strong>Results: </strong>Intention to participate was similar across all conditions (range: 14%-21%). Study interest was higher in the conventional control (<i>M</i> = 3.73) vs the 3 intended-effect designs (<i>P</i> < 0.05), which did not differ (<i>M</i>s = 3.36-3.45). The negative influence of intended-effect designs on study interest was partially mediated by perceived net benefit.</p><p><strong>Conclusion: </strong>Intended-effect RCT designs lower interest in MCD trial participation, in part by reducing prospective participants' perceptions of benefiting from the trial. Strategies to reduce ambiguity do not mitigate this effect.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 2","pages":"23814683261477027"},"PeriodicalIF":1.7,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Impact of VOICE (Values and Outcomes to Improve Cancer Experiences), a Values-Clarification Tool, among Older Adults with Advanced Cancer: A Randomized Study in Simulated Clinical Settings.","authors":"Amy C Cole, Angela M Stover, Andy J King, Allison M Deal, Cameron Pinkelton, Michael Johnson, Lisa Vizer, Fei Yu, Lukasz Mazur, Daniel R Richardson","doi":"10.1177/23814683261480116","DOIUrl":"10.1177/23814683261480116","url":null,"abstract":"<p><strong>Background: </strong>Patients often report that clinical guidance does not reflect personal values, such as balancing survival with quality of life. Values-clarification tools can improve treatment alignment but have been understudied.</p><p><strong>Objective: </strong>To evaluate the impact of the Values and Outcomes to Improve Cancer Experiences (VOICE) tool on values clarification and shared decision making (SDM) in simulated encounters.</p><p><strong>Methods: </strong>Adults (age ≥60 y) with advanced cancer were randomized to receive VOICE or an American Cancer Society (ACS) communication guide. Participants completed 2 simulated decision-making encounters in randomized order, values based (VB; clinician-initiated discussion of patient values) and non-values based (NVB; values addressed only if patient initiates), with medical students. Two independent raters assessed values‑clarification and SDM behaviors (interrater reliability = 0.82). Patient-reported SDM was assessed with validated measures. Postsimulation interviews were thematically analyzed.</p><p><strong>Results: </strong>Forty-four adults (aged 60-88 y) participated in 88 simulated encounters focused on discussing a secondary cancer diagnosis and treatment options. VOICE recipients demonstrated higher rater-assessed values clarification than those receiving the ACS guide in VB (91.5 vs 80.1, <i>P</i> = 0.01) and NVB (25.2 vs 16.2, <i>P</i> = 0.01) encounters. During NVB encounters, more participants receiving VOICE initiated a values discussion (48% vs 13%). Values-clarification ratings were higher when clinicians initiated VB discussions than patient-initiated discussions (92.9 vs 35.7; <i>P</i> < 0.001). Patient-reported SDM was better in VB versus NVB encounters (relative risk [RR] = 1.71, <i>P</i> = 0.04). VOICE better prepared participants for SDM (70.0 vs 0.0; <i>P</i> < 0.001). Qualitative findings suggest VOICE led to greater self-reflection and values clarification.</p><p><strong>Conclusions: </strong>In this randomized simulation study, VOICE improved older adults' preparation for values-based discussions and supported reflection on how treatment options align with what matters most to them. Findings highlight the importance of pairing values-clarification tools with clinician-initiated values-based discussions and for further evaluation in real-world settings.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 2","pages":"23814683261480116"},"PeriodicalIF":1.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating Chronic Kidney Disease Stage Transitions from Irregular Electronic Health Record Data Using an Expectation-Maximization Framework.","authors":"Wendy Qi, Jennifer Mason Lobo, Guofen Yan, Rahwa Ghenbot, Kenneth G Sands, Tracey L Krupski, Stephen H Culp, Daniel F Otero-León","doi":"10.1177/23814683261477362","DOIUrl":"10.1177/23814683261477362","url":null,"abstract":"<p><strong>Objective: </strong>To estimate chronic kidney disease (CKD) stage transition probabilities in patients with small renal masses (SRMs) using irregularly observed electronic health record (EHR) data, addressing challenges of interval censoring and irregular measurement intervals in real-world clinical practice.</p><p><strong>Data sources: </strong>We used EHR data from the institutional Small Renal Mass registry (2006-January 2026), capturing outpatient renal function data prior to any definitive treatment for SRM. CKD stages were defined using estimated glomerular filtration rate (eGFR) thresholds based on KDIGO guidelines.</p><p><strong>Study design: </strong>The final analytic cohort included 527 patients with at least 2 outpatient eGFR measurements prior to definitive treatment. We applied an expectation-maximization (EM) algorithm to estimate discrete-time CKD stage transition matrices while accounting for irregular eGFR measurement intervals and unobserved intermediate transitions. Transition matrices were estimated under 3- and 6-mo cycle lengths overall as well as stratified by age and sex. The likelihood ratio statistic was used to compare EM-based estimates with the empirical counting estimator.</p><p><strong>Results: </strong>The EM framework yielded clinically plausible transition structures dominated by self-transitions and progression primarily to adjacent CKD stages, with reduced spurious backward transitions relative to the empirical estimator. Transition patterns were consistent across 3- and 6-mo cycle lengths. Age-stratified analyses showed that older patients had slightly higher probabilities of progression to more advanced CKD stages compared with younger patients, whereas sex-stratified differences were minimal. Likelihood ratio comparisons supported the consistency of the EM-based models with the observed transition data in both the overall cohort and subgroup analyses.</p><p><strong>Conclusions: </strong>The EM approach provides a principled and computationally efficient method for estimating CKD stage progression from irregularly observed EHR data, yielding transition matrices suitable for discrete-time decision-analytic and health economic models.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 2","pages":"23814683261477362"},"PeriodicalIF":1.7,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13519163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guidelines and Policies as Levers in Managing Carpal Tunnel Release Demand.","authors":"Mikael Hytönen, Aukusti Savolainen, Aleksi Reito, Yrjänä Nietosvaara, Ville Mattila, Matti Juntunen, Mikko P Räisänen","doi":"10.1177/23814683261477058","DOIUrl":"10.1177/23814683261477058","url":null,"abstract":"<p><strong>Background: </strong>National guidelines and health policy measures can influence both demand for and delivery of elective surgery as well as the setting in which procedures are performed. Carpal tunnel release (CTR), one of the most common elective operations, provides a useful case for examining these effects. This study addresses 2 key research objectives: 1) the evaluation of the impact of Finland's 2007 guideline requiring preoperative electromyoneurography on CTR incidence trends and 2) the assessment of trends in the adoption of procedural room (PR) surgery in university hospitals.</p><p><strong>Methods: </strong>We used Finnish National Hospital Discharge Register (NHDR) data to identify all CTR procedures between 1997 and 2021. The years 2020 to 2021 were excluded due to the COVID-19 pandemic. Negative binomial regression models with population offset were used to estimate annual changes in incidence, adjusted for age and sex. Age- and sex-standardized incidence rates were calculated using direct standardization. Pre- and postguideline period analyses were performed. University hospital records (2017-2025) were analyzed to determine the rates of PR-based CTR.</p><p><strong>Results: </strong>Between 1997 and 2019, 181,552 CTR procedures were performed in Finland. The age- and sex-standardized incidence increased from 91.9 to 233 per 100,000 person-years. From 1997 to 2007, the incidence of CTR increased by 7.5% annually (<i>P</i> < 0.001), whereas after the 2007 guideline, the increase slowed to 1.2% annually (<i>P</i> < 0.001). From 2017 to 2025, 4 of 5 Finnish university hospitals shifted most CTR operations from operating theaters to PRs, demonstrating rapid institution-level adaptation.</p><p><strong>Conclusion: </strong>The 2007 national guideline was associated with a marked reduction in CTR incidence growth. The move to PR-based CTR in university hospitals illustrates a high-impact policy strategy for reducing costs, reallocating operating theater capacity, and promoting more sustainable surgical care.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 2","pages":"23814683261477058"},"PeriodicalIF":1.7,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The 4-Circles Tool 2.0-A Tool to Prepare Older Patients for Shared Decision Making: A Developmental and Feasibility Study.","authors":"Stephanie von Helden-Lenzen, Maartje Feuler, Albine Moser, Jolanda Friesen-Storms, Ruth Dalemans, Emmylou Beekman","doi":"10.1177/23814683261458330","DOIUrl":"10.1177/23814683261458330","url":null,"abstract":"<p><strong>Background: </strong>Shared decision making is an effective strategy for collaborative goal setting and action planning with older patients. However, many older patients feel unable to actively participate. Increasing patient participation requires preparing patients for this process. The 4-Circles tool, a validated visual tool designed to support the goal setting phase of shared decision making, might serve as a preparation tool. This study describes the development of the 4-Circles tool 2.0 and examines its feasibility.</p><p><strong>Methods: </strong>We applied a human-centered design consisting of 3 phases: developing a prototype, exploring feasibility, and finalizing the 4-Circles tool 2.0. Data were collected through co-creation sessions with older patients (<i>n</i> = 9), primary care professionals (<i>n</i> = 10), and experts (<i>n</i> = 3) as well as through (focus group) interviews with primary care professionals (<i>n</i> = 8) and interviews with older patients (<i>n</i> = 8). We applied conventional content analysis.</p><p><strong>Results: </strong>The 4-Circles tool 2.0 is a self-reflection booklet accompanied by training for professionals. The feasibility analysis showed that professionals gained deeper insights into older patients' personal goals. Older patients reported finding it easier to articulate their goals. However, professionals perceived that some older patients might lack the cognitive abilities required to complete the tool, adopted a passive role, or feared giving \"wrong\" answers. For some older patients, goal setting was not considered valuable because they perceived their potential for improvement as limited.</p><p><strong>Conclusion and implications: </strong>Feasibility testing of the 4-Circles tool 2.0 showed that professionals gained deeper insights into older patients' goals. However, using self-reflection tools such as the 4-Circles tool 2.0 may be challenging because of the power asymmetry experienced between professionals and older patients. This issue should be addressed more actively during the implementation of such tools.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 2","pages":"23814683261458330"},"PeriodicalIF":1.7,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13443255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating the Quality-Adjusted Life-Year Loss due to Fatal and Nonfatal COVID-19 Outcomes across US States and Counties, July 2020 to December 2022.","authors":"Fatima Mikdashi, Rachel E Murray-Watson, Rafael Lopes, Alyssa Bilinski, Reza Yaesoubi","doi":"10.1177/23814683261461551","DOIUrl":"10.1177/23814683261461551","url":null,"abstract":"<p><strong>Objective: </strong>The population-level quality-of-life impact of nonfatal health outcomes, including prolonged hospitalizations and long COVID, remains poorly understood. In this study, we estimate the cumulative quality-adjusted life-year (QALY) loss attributable to fatal and nonfatal COVID-19 outcomes in the United States and compare that burden with that of other diseases.</p><p><strong>Methods: </strong>We developed a probabilistic model that accounts for the loss in population health due to COVID-19 symptoms, hospitalizations, long COVID, and deaths. The model was applied to weekly county-level data from July 2020 to December 2022. We used appropriate probability distributions to describe uncertainty in parameter values and used 1,000 repeated samples from these distributions to estimate the expected QALY loss and the 95% uncertainty interval (UI).</p><p><strong>Results: </strong>We estimate the cumulative QALY loss as 9,242,000 (95% UI: 7,808,000-11,311,000) life-years. Following deaths, long COVID was the second most significant contributor to QALY loss, with an estimated annual QALY loss of approximately 865,000 (95% UI: 355,000-1,591,000). This burden is comparable to the total annual disability-adjusted life-years (DALYs) associated with liver cancer: 581,000 DALYs (95% UI: 549,000-607,000). Although symptomatic infections contributed less to overall QALY loss, their burden was comparable to that of HIV/AIDS (377,000 DALYs, 95% UI: 309,000-465,000).</p><p><strong>Conclusion: </strong>The quality-of-life burden of nonfatal COVID-19 outcomes, particularly long COVID, is on the same scale as that of major chronic and infectious diseases. As COVID-19 mortality declines and the pandemic transitions to an endemic phase, it is essential to recognize and address the long-term effects of nonfatal outcomes as public health priorities.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 2","pages":"23814683261461551"},"PeriodicalIF":1.7,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensibility of Fact Sheets Addressing Benefits and Risks of Preventive Interventions: A Cross-Sectional Evaluation Study.","authors":"Bigna Hut, Stefania Di Gangi, Giuseppe Pichierri, Oliver Senn, Stefan Neuner-Jehle, Andreas Plate","doi":"10.1177/23814683261462594","DOIUrl":"10.1177/23814683261462594","url":null,"abstract":"<p><strong>Background: </strong>Preventive tests and procedures (PTPs) help to reduce disease burden. However, patient expectations often differ from current guidelines, resulting in overuse or underuse of PTPs. Shared decision making can bridge this gap but requires clear, evidence-based information. This study aimed to develop and conduct an initial evaluation of prototype fact sheets designed to support informed decisions about PTPs.</p><p><strong>Methods: </strong>We selected 11 PTPs based on their potential for over- or underuse. For each, we developed a fact sheet following guideline recommendations. These summarised key benefits, risks and relevance using verbal, numerical and graphical formats. User experience and comprehensibility were assessed through a survey among a university population. Participants rated comprehensibility, content and design on a 5-point scale. Approval was defined as the proportion of 'very good' or 'rather good' ratings. Participants giving poor ratings were invited to provide free-text comments. Subgroup analyses were performed by age and educational level.</p><p><strong>Results: </strong>A total of 2,082 individuals answered all relevant questions to fact sheets. The median fact sheet approval score was 77% (interquartile range: 55%, 91%). Six of the 11 fact sheets received an approval of greater than 80% for comprehensibility in general. Lower approval was reported for risk descriptions, usefulness in doctor-patient conversations and visuals. Cancer screening sheets scored the lowest. Subgroup analyses showed lower approval in younger age groups and among individuals with higher levels of education.</p><p><strong>Conclusions: </strong>Initial user testing of the fact sheets showed generally positive ratings regarding comprehensibility and user experience. However, the presentation of specific risks and the use of visuals needed to be adapted, especially for cancer-related topics. The findings highlighted the importance of tailoring informational materials to effectively support shared decision making.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 2","pages":"23814683261462594"},"PeriodicalIF":1.7,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13379673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148498255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing and Piloting an Instrument to Prioritize the Worries of Female Youth with a Physical Disability and Mothers during the Transition to Adulthood.","authors":"Courtney S Streur, Dalia Elased, Jodi M Kreschmer, Rebecca Parten, Hamoud Alhazmi, Brittany Gay, Ashley Duby, Henrike L Schmalfuss, Jenna Goldstein, Grayson N Holmbeck, Lisa A Prosser, John F P Bridges","doi":"10.1177/23814683261457144","DOIUrl":"10.1177/23814683261457144","url":null,"abstract":"<p><strong>Background: </strong>The transition to adulthood is a worrying time for female youth with a physical disability and their mothers. We sought to develop an instrument to assess which transition-related worries are most (and least) worrisome to youth and mothers to inform transition preparation interventions.</p><p><strong>Design: </strong>A community-centered approach was used to identify and refine the most common transition-related worries of youth and mothers. A novel best-worst scaling (BWS) instrument was created in partnership with an advisory board of female youth with a physical disability and their mothers. BWS is a theory-driven survey method to identify priorities. The instrument was then pretested, refined, and piloted with youth and mothers. Findings were assessed by consultation with stakeholders.</p><p><strong>Results: </strong>After input from youth and mothers, 11 transition-related worries were included in the pilot instrument using an object case experimental design. Pilot testing was conducted with 22 youth and 16 mothers, including 3 mother-daughter dyads. The completion rate was 86% for youth and 100% for mothers. The instrument was sensitive enough to detect differences between youth and mothers at both the aggregate and dyad level. On aggregate, both youth and mothers worried more about health-related compared to social-related worries but differed on the prioritization of independence-related worries. Discussion of results with participants and an advocacy group confirmed the face validity of the findings.</p><p><strong>Limitations: </strong>Male youth and fathers were not included.</p><p><strong>Conclusions: </strong>The novel BWS instrument is feasible for female youth and mothers to complete independently and was valid in prioritizing worries on the aggregate and dyad levels.</p><p><strong>Implications: </strong>A subsequent large-scale study using the instrument may inform transition initiatives, while use among in a clinical setting may guide decision making.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 1","pages":"23814683261457144"},"PeriodicalIF":1.7,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeted versus Universally Offered Screening in Pediatric Emergency Departments: Cost-Effectiveness.","authors":"Mark H Eckman, Monika K Goyal, T Charles Casper, Chella Palmer, Jennifer L Reed","doi":"10.1177/23814683261460886","DOIUrl":"10.1177/23814683261460886","url":null,"abstract":"<p><strong>Background: </strong>Adolescents and young adults (AYA) comprise 50% of sexually transmitted infections (STIs) diagnosed annually. AYA frequently access emergency departments (EDs) for health care. Thus, the ED could be a strategic venue for the diagnosis and treatment of STIs.</p><p><strong>Objective: </strong>Cost-effectiveness analysis examining screening strategies for <i>Chlamydia trachomatis</i> and <i>Neisseria gonorrhea</i> (CT/GC).</p><p><strong>Design: </strong>Decision analytic cost-effectiveness model.</p><p><strong>Setting: </strong>Six pediatric EDs.</p><p><strong>Participants: </strong>AYA 15 to 21 y of age seeking acute care at pediatric EDs.</p><p><strong>Interventions: </strong>1) Usual care, 2) targeted screening (using a computerized sexual health survey), and 3) universally offered screening.</p><p><strong>Main outcomes and measures: </strong>Cost in 2024 US dollars and effectiveness measured as STIs detected and successfully treated. Secondary effectiveness outcome metric: quality-adjusted life-years (QALYs). The cost perspective is the direct health care sector, and the time horizon is lifelong.</p><p><strong>Results: </strong>Targeted screening was the most effective and most costly (incremental cost-effectiveness ratio [ICER] of $517 per case detected and successfully treated). In a secondary analysis using QALYs lost for long-term complications of untreated CT/GC, targeted screening had an ICER of $23,320/QALY. In this analysis, usual care was dominated, being more costly and less effective than universally offered screening. In subgroup analyses of female versus male, only cohorts using $/QALY, targeted screening remained highly cost-effective for females ($6,389/QALY) compared with universally offered screening but was not cost-effective in males.</p><p><strong>Conclusions and relevance: </strong>Targeted screening is a highly cost-effective strategy for detecting and treating STIs in adolescents seeking pediatric ED care compared with universally offered screening, with an ICER of $517 per case detected and treated. When considering quality of life for female- versus male-only subgroups, screening for males becomes less clear.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 1","pages":"23814683261460886"},"PeriodicalIF":1.7,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Implementing Alternative Human Papillomavirus (HPV) Vaccination Strategies in Kenya: A Modeling Study.","authors":"Valerian Mwenda, Joan-Paula Bor, Rose Jalang'o, Anne Musuva, Allison Portnoy","doi":"10.1177/23814683261456695","DOIUrl":"10.1177/23814683261456695","url":null,"abstract":"<p><strong>Background: </strong>Implementation delays reduce population-level effects of evidence-based interventions. We conducted a modeling study to estimate the effect of priority policy decisions on a human papillomavirus (HPV) vaccination program in Kenya.</p><p><strong>Methods: </strong>We used a static cohort model to estimate the health effects and costs of introduction and 1-dose switch delays, switching to nonavalent vaccine (9vHPV), supply disruptions, and various scale-up scenarios. Costs were evaluated from the health system perspective. We estimated cervical cancer cases, deaths, disability-adjusted life-years (DALYs), and program and health care costs.</p><p><strong>Results: </strong>Compared with no vaccination, maintaining current program performance would avert approximately 173,000 (95% UI: 149,000-191,000) cases and 2.7 (2.3-3.0) million DALYs across 2019 to 2100. A gradual scale-up of the current 2-dose quadrivalent vaccine (4vHPV) program would avert an additional 16,000 (14-18,000) cases (9%), increasing to 33,000 (28-37,000) cases (19%) if a multiage catchup is implemented in 2030. Accelerated scale-up of 1-dose bivalent vaccine (2vHPV) would avert 184,000 (164-199,000) cases and 3.0 (2.6-3.2) million DALYs, compared with no vaccination; translating to an additional 11,000 (2-17,000) cases averted (6%) compared with maintaining a 2-dose strategy, but at lower program ($81 million vs $76 million) and treatment costs ($2.09 billion vs $2.07 billion). HPV vaccination introduction in 2015 rather than 2019 would have averted an additional 74,000 (43%) cases. Annual vaccine supply disruptions translates to less than 9,000 (200-16,000) cases (5%) and 212,000 (74-305,000) DALYs averted (7%) compared with a 1-dose strategy. A 1-dose 9vHPV strategy would have more health benefits and save additional treatment costs compared with a 1-dose 2vHPV vaccine.</p><p><strong>Conclusions: </strong>Prompt 1-dose switch and rapid scale-up and adoption of a 9vHPV program should be priority policy decisions for Kenya.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 1","pages":"23814683261456695"},"PeriodicalIF":1.7,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}