Kine Pedersen

• Cyr, Pascale Renée; Pedersen, Kine; Iyer, Anita Lakshmi; Bundorf, Kate; Goldhaber-Fiebert, Jeremy & Gyrd-Hansen, Dorte [Vis alle 8 forfattere av denne artikkelen] (2021). Providing more balanced information on the harms and benefits of cervical cancer screening: A randomized survey among US and Norwegian women. Preventive Medicine Reports. ISSN 2211-3355. doi: 10.1016/j.pmedr.2021.101452. Fulltekst i vitenarkiv Vis sammendrag

  We aimed to identify how additional information about benefits and harms of cervical cancer (CC) screening impacted intention to participate in screening, what type of information on harms women preferred receiving, from whom, and whether it differed between two national healthcare settings. We conducted a survey that randomized screen-eligible women in the United States (n = 1084) and Norway (n = 1060) into four groups according to the timing of introducing additional information. We found that additional information did not significantly impact stated intentions-to-participate in screening or follow-up testing in either country; however, the proportion of Norwegian women stating uncertainty about seeking precancer treatment increased from 7.9% to 14.3% (p = 0.012). Women reported strong system-specific preferences for sources of information: Norwegians (59%) preferred it come from a national public health agency while Americans (59%) preferred it come from a specialist care provider. Regression models revealed having a prior Pap-test was the most important predictor of intentions-to-participate in both countries, while having lower income reduced the probabilities of intentions-to-follow-up and seek precancer treatment among U.S. women. These results suggest that additional information on harms is unlikely to reduce participation in CC screening but could increase decision uncertainty to seek treatment. Providing unbiased information would improve on the ethical principle of respect for autonomy and self-determination. However, the clinical impact of additional information on women's understanding of the trade-offs involved with CC screening should be investigated. Future studies should also consider country-specific socioeconomic barriers to screening if communication re-design initiatives aim to improve CC screening participation.

• Pedersen, Kine; Portnoy, Allison; Sy, Stephen; Hansen, Bo T.; Tropé, Ameli & Kim, Jane J. [Vis alle 7 forfattere av denne artikkelen] (2021). Switching clinic-based cervical cancer screening programs to human papillomavirus self-sampling: A cost-effectiveness analysis of vaccinated and unvaccinated Norwegian women. International Journal of Cancer. ISSN 0020-7136. doi: 10.1002/ijc.33850. Fulltekst i vitenarkiv Vis sammendrag

  Several countries have implemented primary human papillomavirus (HPV) testing for cervical cancer screening. HPV testing enables home-based, self-collected sampling (self-sampling), which provides similar diagnostic accuracy as clinician-collected samples. We evaluated the impact and cost-effectiveness of switching an entire organized screening program to primary HPV self-sampling among cohorts of HPV vaccinated and unvaccinated Norwegian women. We conducted a model-based analysis to project long-term health and economic outcomes for birth cohorts with different HPV vaccine exposure, that is, preadolescent vaccination (2000- and 2008-cohorts), multiage cohort vaccination (1991-cohort) or no vaccination (1985- cohort). We compared the cost-effectiveness of switching current guidelines with clinician-collected HPV testing to HPV self-sampling for these cohorts and considered an additional 44 strategies involving either HPV self-sampling or clinician-collected HPV testing at different screening frequencies for the 2000- and 2008-cohorts. Given Norwegian benchmarks for cost-effectiveness, we considered a strategy with an additional cost per quality-adjusted life-year below $55 000 as cost-effective. HPV selfsampling strategies considerably reduced screening costs (ie, by 24%-40% across cohorts and alternative strategies) and were more cost-effective than cliniciancollected HPV testing. For cohorts offered preadolescent vaccination, cost-effective strategies involved HPV self-sampling three times (2000-cohort) and twice (2008-cohort) per lifetime. In conclusion, we found that switching from cliniciancollected to self-collected HPV testing in cervical screening may be cost-effective among both highly vaccinated and unvaccinated cohorts of Norwegian women.

• Portnoy, Allison; Pedersen, Kine; Trogstad, Lill; Hansen, Bo Terning; Feiring, Berit & Laake, Ida [Vis alle 11 forfattere av denne artikkelen] (2021). Impact and cost-effectiveness of strategies to accelerate cervical cancer elimination: A model-based analysis. Preventive Medicine. ISSN 0091-7435. 144. doi: 10.1016/j.ypmed.2020.106276. Fulltekst i vitenarkiv
• Fogelberg, Sara; Clements, Mark; Pedersen, Kine; Sy, Stephen; Sparén, Pär & Kim, Jane J. [Vis alle 7 forfattere av denne artikkelen] (2020). Cost-effectiveness of cervical cancer screening with primary HPV testing for unvaccinated women in Sweden. PLOS ONE. ISSN 1932-6203. 15(9). doi: 10.1371/journal.pone.0239611.
• Hylin, Hannah Douglass; Thrane, Helene; Pedersen, Kine; Kristiansen, Ivar Sønbø & Burger, Emily (2019). The healthcare costs of treating human papillomavirus-related cancers in Norway. BMC Cancer. ISSN 1471-2407. 19(1). doi: 10.1186/s12885-019-5596-2. Fulltekst i vitenarkiv
• Aas, Eline; Burger, Emily & Pedersen, Kine (2019). Economic Evaluation of Medical Screening. I Hamilton, Jonathan H. (Red.), Oxford Research Encyclopedias: Economics and Finance. Oxford University Press. ISSN 9780190625979. doi: doi%3A%2010.1093/acrefore/9780190625979.013.377. Fulltekst i vitenarkiv
• Pedersen, Kine; Fogelberg, Sara; Thamsborg, Lise H.; Clements, Mark; Nygård, Mari & Kristiansen, Ivar Sønbø [Vis alle 10 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv
• 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
• 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; 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
• 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

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• Portnoy, Allison; Pedersen, Kine; Trogstad, Lill; Hansen, Bo Terning; Feiring, Berit & Laake, Ida [Vis alle 11 forfattere av denne artikkelen] (2021). Cost-effectiveness of nonavalent HPV vaccine in Norway considering current empirical data and validation. Preventive Medicine. ISSN 0091-7435. doi: 10.1016/j.ypmed.2021.106688.
• 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; 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; 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 (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; 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.

• Groeneveld, linn; Engesæter, Birgit; Aasbø, Gunvor; Hansen, Mona; Christiansen, Irene Kraus & Berland, Jannicke [Vis alle 14 forfattere av denne artikkelen] (2021). Prosjektforslag hjemmetest: Implementering av hjemmeprøvetaking i Livmorhalsprogrammet. Kreftregisteret. Fulltekst i vitenarkiv
• Abelsen, Birgit; Gaski, Margrete; Godager, Geir; Løyland, Hanna Isabel; Pedersen, Kine & Snilsberg, Øyvind [Vis alle 9 forfattere av denne artikkelen] (2019). Evaluering av pilotprosjekt med primærhelseteam og alternative finansieringsordninger. Statusrapport II. Helsedirektoratet.
• Abelsen, Birgit; Gaski, Margrete; Godager, Geir; Iversen, Tor; Løyland, Hanna Isabel & Pedersen, Kine [Vis alle 7 forfattere av denne artikkelen] (2019). Evaluering av pilotprosjekt med primærhelseteam og alternative finansieringsordninger. Statusrapport 2 . Universitetet i Oslo.

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