OBJECTIVE: To estimate the cost per life-year saved (cost-effectiveness ratio [CER]) for cervical cancer and to evaluate the influence of the decreased incidence upon the cost per life-year saved. STUDY DESIGN: We established hypothetical cohorts at 10-year intervals between 30 and 79 years of age, each of which consisted of 100,000 asymptomatic female subjects, and estimated the cost and effect of single mass screening for cervical cancer. To investigate the influence on CER, we performed a sensitivity analysis of each item, including the consultation rate for further examination, prevalence rate and cost of medical treatment. RESULTS: The estimated CER per one expected life-year of survival was lowest for subjects in their 30s and highest for those in their 70s. The difference between the two was more than five-fold. Sensitivity analysis was rarely affected by changes in the cost of medical treatment and the prevalence rate, but the effectiveness rate could be fairly affected by the consultation rate for closer examination. CONCLUSION: Mass screening for cervical cancer is acceptable in terms of economic effectiveness. Moreover, mass screening for cervical cancer could decrease the morbidity rate for scores of years thereafter.

Adult↗

PubMedDate not supplied

Clinical significance of nocturnal blood pressure monitoring.

Although there are certain technical problems in determining nocturnal BP by ambulatory BP monitoring, the information provided on nocturnal BP has possible clinical significance. Short-term BP variability, an elevated BP during sleep and amplitude and sleep of nocturnal BP decline might be responsible for cardiovascular mortality. Furthermore, circadian BP variation might also be responsible for cardiovascular morbidity and mortality. The nocturnal BP level, even in extreme dippers with diurnal hypertension, is equivalent to or higher than that in normotensive subjects. Antihypertensive effects of drugs with different pharmacologic properties positively correlate with basal ambulatory BP. Therefore, there is a critical BP level at which the antihypertensive effect disappears. The critical BP level for each drug is in normal BP range but not in the hypotensive range. Therefore, an antihypertensive regimen would be safe even in extreme-dipper hypertension without excessive nocturnal hypotension, and might even be beneficial because of the decreasing amplitude and speed of the nocturnal BP decline. We conclude that an antihypertensive drug regimen should control BP throughout a 24-h period regardless of circadian BP variation.

Antihypertensive Agents↗