Kine Pedersen

• Pedersen, Kine; Burger, Emily; Nygård, Mari; Kristiansen, Ivar Sønbø & Kim, Jane J. (2018). Adapting cervical cancer screening for women vaccinated against human papillomavirus infections: The value of stratifying guidelines. European Journal of Cancer.  ISSN 0959-8049.  91, s 68- 75 . doi: 10.1016/j.ejca.2017.12.018 Fulltekst i vitenarkiv.
• Pedersen, Kine; Fogelberg, Sara; Thamsborg, Lise H.; Clements, Mark; Nygård, Mari; Kristiansen, Ivar Sønbø; Lynge, Elsebeth; Sparén, Pär; Kim, Jane J & Burger, Emily (2018). An overview of cervical cancer epidemiology and prevention in Scandinavia. Acta Obstetricia et Gynecologica Scandinavica.  ISSN 0001-6349.  97(7), s 795- 807 . doi: 10.1111/aogs.13313
• Burger, Emily; Pedersen, Kine; Sy, Stephen; Kristiansen, Ivar Sønbø & Kim, Jane J (2017). Choosing wisely: a model-based analysis evaluating the trade-offs in cancer benefit and diagnostic referrals among alternative HPV testing strategies in Norway. British Journal of Cancer.  ISSN 0007-0920.  117(6), s 783- 790 . doi: 10.1038/bjc.2017.248 Fulltekst i vitenarkiv.
• Pedersen, Kine; Burger, Emily; Campbell, Suzanne; Nygård, Mari; Aas, Eline & Lönnberg, Stefan (2017). Advancing the evaluation of cervical cancer screening: development and application of a longitudinal adherence metric. European Journal of Public Health.  ISSN 1101-1262. . doi: /10.1093/eurpub/ckx073 Fulltekst i vitenarkiv.
• Pedersen, Kine; Sørbye, Sveinung Wergeland; Kristiansen, Ivar Sønbø & Burger, Emily (2017). Using novel biomarkers to triage young adult women with minor cervical lesions: a cost-effectiveness analysis. BJOG: an International Journal of Obstetrics and Gynaecology.  ISSN 1470-0328.  124(3), s 474- 484 . doi: 10.1111/1471-0528.14135 Vis sammendrag

  Objective To evaluate the short-term consequences and cost-effectiveness associated with the use of novel biomarkers to triage young adult women with minor cervical cytological lesions. Design Model-based economic evaluation using primary epidemiological data from Norway, supplemented with data from European and American clinical trials. Setting Organised cervical cancer screening in Norway. Population Women aged 25–33 years with minor cervical cytological lesions detected at their primary screening test. Methods We expanded an existing simulation model to compare 12 triage strategies involving alternative biomarkers (i.e. reflex human papillomavirus (HPV) DNA/mRNA testing, genotyping, and dual staining) with the current Norwegian triage guidelines. Main outcome measures The number of high-grade precancers detected and resource use (e.g. monetary costs and colposcopy referrals) for a single screening round (3 years) for each triage strategy. Cost-efficiency, defined as the additional cost per additional precancer detected of each strategy compared with the next most costly strategy. Results Five strategies were identified as cost-efficient, and are projected to increase the precancer detection rate between 18 and 57%, compared with current guidelines; however, the strategies did not uniformly require additional resources. Strategies involving HPV mRNA testing required fewer resources, whereas HPV DNA-based strategies detected >50% more precancers, but were more costly and required twice as many colposcopy referrals compared with the current guidelines. Conclusion Strategies involving biomarkers to triage younger women with minor cervical cytological lesions have the potential to detect additional precancers, yet the optimal strategy depends on the resources available as well as decision-makers' and women's acceptance of additional screening procedures.

• Melberg, Hans Olav; Olsen, Camilla Beck & Pedersen, Kine (2016). Did hospitals respond to changes in weights of Diagnosis Related Groups in Norway between 2006 and 2013?. Health Policy.  ISSN 0168-8510.  120(9), s 992- 1000 . doi: 10.1016/j.healthpol.2016.07.013 Vis sammendrag

  Abstract It has been argued that activity based payment systems make hospitals focus on the diagnostic groups that are most beneficial given costs and reimbursement rates. This article tests this hypothesis by exploring the relationship between changes in the reimbursement rates and changes in the number of registered treatment episodes for all diagnosis-related groups in Norway between 2006 and 2013. The number of treatment episodes can be affected by many factors and in order to isolate the effect of changes in the reimbursement system, we exclude DRGs affected by policy reforms and administrative changes. The results show that hospitals increased the number of admissions in a specific DRG four times more when the reimbursement was increased, relative to the change for DRGs with reduced rates. The direction of the result was consistent across time periods and sub-groups such as surgical vs. medical, and inpatient vs. outpatient DRGs. The effect was smaller, but remained significant after eliminating DRGs that were most likely to be affected by upcoding. Activities that the hospital had little control over, such as the number of births, had small effects, while activity levels in more discretionary categories, for instance mental diseases, were more affected. This demonstrates that contrary to the wishes of policy makers the economic incentives affect hospital reporting and priority setting behavior.

• Pedersen, Kine; Burger, Emily; Sy, Stephen; Kristiansen, Ivar Sønbø & Kim, Jane J. (2016). Cost-effective management of women with minor cervical lesions: Revisiting the application of HPV DNA testing.. Gynecologic Oncology.  ISSN 0090-8258.  143(2), s 326- 333 . doi: 10.1016/j.ygyno.2016.08.231 Fulltekst i vitenarkiv. Vis sammendrag

  Background Lack of consensus in management guidelines for women with minor cervical lesions, coupled with novel screening approaches, such as human papillomavirus (HPV) genotyping, necessitate revisiting prevention policies. We evaluated the cost-effectiveness and resource trade-offs of alternative triage strategies to inform cervical cancer prevention in Norway. Methods We used a decision-analytic model to compare the lifetime health and economic consequences associated with ten novel candidate approaches to triage women with minor cervical lesions. Candidate strategies varied by: 1) the triage test(s): HPV testing in combination with cytology, HPV testing alone with or without genotyping for HPV-16 and -18, and immediate colposcopy, and 2) the length of time between index and triage testing (i.e., 6, 12 or 18 months). Model outcomes included quality-adjusted life-years (QALYs), lifetime societal costs, and resource use (e.g., colposcopy referrals). Results The current Norwegian guidelines were less effective and more costly than candidate strategies. Given a commonly-cited willingness-to-pay threshold in Norway of $100,000 per QALY gained, the preferred strategy involved HPV genotyping with immediate colposcopy referral for HPV-16 or -18 positive and repeat HPV testing at 12 months for non-HPV-16 or -18 positive ($78,010 per QALY gained). Differences in health benefits among candidate strategies were small, while resource use varied substantially. More effective strategies required a moderate increase in colposcopy referrals (e.g., a 9% increase for the preferred strategy) compared with current levels. Conclusion New applications of HPV testing may improve management of women with minor cervical lesions, yet are accompanied by a trade-off of increased follow-up procedures.

• Pedersen, Kine; Lönnberg, Stefan; Skare, Gry Baadstrand; Sørbye, Sveinung Wergeland; Burger, Emily & Kristiansen, Ivar Sønbø (2015). Kostnader ved Masseundersøkelsen mot livmorhalskreft. Sykepleien Forskning.  ISSN 1890-2936.  s 62- 71 . doi: 10.4220/Sykepleienf.2015.53414 Fulltekst i vitenarkiv.
• Pedersen, Kine; Sørbye, Sveinung Wergeland; Burger, Emily; Lönnberg, Stefan & Kristiansen, Ivar Sønbø (2015). Using decision-analytic modeling to isolate interventions that are feasible, efficient and optimal: an application from the Norwegian Cervical Cancer Screening Program. Value in Health.  ISSN 1098-3015.  18(8), s 1088- 1097 . doi: 10.1016/j.jval.2015.08.003 Fulltekst i vitenarkiv.

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• Burger, Emily; Pedersen, Kine; Sy, Stephen; Kristiansen, Ivar Sønbø & Kim, Jane J. (2017). Primary HPV-based Cervical Cancer Screening: Balancing Health Benefits Colposcopy Referrals.
• Pedersen, Kine; Burger, Emily; Sy, Stephen; Kristiansen, Ivar Sønbø & Kim, Jane J. (2016). Cost-effective management of women with minor cervical lesions: Revisiting the application of HPV DNA testing.
• Pedersen, Kine (2015). Kostnad-nytte-avveininger i screening mot livmorhalskreft. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  135(11), s 1022- 1023 . doi: 10.4045/tidsskr.15.0468
• Pedersen, Kine; Burger, Emily; Campbell, Suzanne; Nygård, Mari & Lönnberg, Stefan (2015). Risk of cervical cancer by screening intensity: A registry-based analysis.
• Pedersen, Kine; Sørbye, Sveinung Wergeland; Burger, Emily; Lönnberg, Stefan & Kristiansen, Ivar Sønbø (2015). Quantifying benefits and harms in cervical cancer screening: A decision analytic approach.
• Pedersen, Kine; Sørbye, Sveinung Wergeland; Kristiansen, Ivar Sønbø & Burger, Emily (2015). Novel Biomarkers to Triage Women with Minor Cervical Lesions: Quantifying the Cost-Effectiveness Tradeoffs to Ensure Feasible Implementation..
• Pedersen, Kine; Sørbye, Sveinung Wergeland; Lönnberg, Stefan; Burger, Emily & Kristiansen, Ivar Sønbø (2014). Trade-offs in cervial cancer screening - Balancing detected cancer precursors and resource use. Vis sammendrag

  Reflex HPV-testing allows for improvements in both effectiveness and cost-effectiveness of the current screening algorithm. Candidate strategies can detect a larger number of precancers while using fewer resources compared to current practice; however, the optimal strategy depends on society’s willingness to pay costs and accept harms. Ultimately, the down-stream effectiveness of the alternative algorithms will depend on the extent to which precancers regress or progress into cancer.

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