Highlights
Rurality has been shown to negatively impact breast cancer screening rates.
We observed mammography outcomes within a sample of low-income uninsured women.
We found that outcomes were independent of sociodemographic factors, like rurality.
More research should explore whether this relationship is mediated by other factors.
Background:
Most studies examining cervical cancer screening outcomes have focused on either an age-specific diagnosis and outcomes of abnormal smears or frequency of abnormal outcomes among a sample of insured women. Thus, it is unclear what the distribution outcomes would be when other sociodemographic characteristics are considered. This study examines the variation in cervical cancer screening outcomes and sociodemographic characteristics (patients' age, marital status, race/ethnicity, rurality, and Papanicolaou [Pap] test screening history) within a sample of low-income and uninsured women.
Materials and Methods:
Our grant-funded program provided 751 Pap tests, 577 human papillomavirus (HPV) tests, and 262 colposcopies to 841 women between 2013 and 2019. Observed outcomes for each procedure type were cross-tabulated by patients' sociodemographic characteristics. Chi-squared and Fisher's exact tests were used to test the independence of screening outcomes and sociodemographic characteristics.
Results:
The overall positivity rate was 7.2% for Pap tests (
n
= 54/751), 3.6% for HPV tests (
n
= 21/577), and 44.7% for colposcopies (
n
= 117/262). Significance tests suggested that the Pap test and colposcopy outcomes we observed were independent of sociodemographic characteristics in all but one instance—Pap test outcomes were not independent of patient age (
p
= 0.009). Moreover, the Pap test positivity rate increased with patient age.
Conclusions:
Our findings support recommendations to discontinue screening for women older than 65 years at low risk for cervical cancer. Our ability to identify an association between cervical screening outcomes and other sociodemographic characteristics may have been limited by our small sample size. This highlights an important barrier to studying health outcomes within low-income and uninsured populations, which are often missing in larger research data sets (
e.g.
, claims).
Nitrofurantoin, trimethoprim-sulfamethoxazole (TMP-SMX) and fosfomycin are first-line therapeutics for uncomplicated urinary tract infections (uUTI). While fosfomycin is the most expensive, it is also attractive due to its effectiveness against most uUTI-causing bacteria, limited risk of cross-resistance with other drugs, and single-dose delivery. In light of these competing attributes, a cost-effectiveness analysis can provide useful, standardized information about tradeoffs between fosfomycin and treatment alternatives. This paper assessed cost-effectiveness via incremental cost-effectiveness ratios (ICERs) that represented a drug’s incremental cost per additional uUTI case resolved with initial course of antibiotic therapy. The study setting was New Hampshire, USA. Total cost of treatment was lowest with TMP-SMX and highest with fosfomycin. ICERs were $84.53 and $78.59 for nitrofurantoin and $2264.29 and $2260.89 for fosfomycin under a payer and societal perspective, respectively. While no standard benchmark for our measure of cost-effectiveness exists, the high national prevalence of antibiotic stewardship efforts suggests that willingness-to-pay to increase the number of people who are successfully treated with an initial course of therapy is non-zero. Ultimately, fosfomycin may currently be considered a cost-effective option for treating uUTI in the US. As a recently off-patent drug, increased competition in the generic market may improve its cost-effectiveness in the future.
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