Gyrd-Hansen D, Hølund B, Andersen P
Center for Health and Social Policy, Odense University, Denmark.
Health Policy. 1995 Oct;34(1):35-51. doi: 10.1016/0168-8510(95)00720-d.
This paper presents a framework for comparison of screening programme designs, based on efficiency and cost effectiveness criteria. The design parameters, such as choice of screening interval, which population segments to screen and expected participation rates in the selected population segments, are varied simultaneously. The costs and effects for a range of existing and hypothetical screening programmes against cervical cancer are estimated, using a mathematical simulation model. On the basis of these estimates average costs per life year and marginal costs per life year are calculated for a range of programmes. These calculations result in the definition of a range of inefficient programmes. Moreover, it is illustrated that the cost effectiveness of the efficient screening programmes decreases at an increasing rate as programmes are intensified either by way of shortening the screening interval or extending the target population segment to encompass the very young and/or the very old. The conclusion of this paper is that one should probably not extend screening programmes against cervical cancer beyond screening women in the age group 25-59 years every 4 years. In addition, increasing the participation rate of this group is a more cost effective way of increasing the number of life years gained, rather than extending the target group or decreasing the screening interval.
本文提出了一个基于效率和成本效益标准的筛查项目设计比较框架。设计参数，如筛查间隔的选择、筛查哪些人群以及所选人群的预期参与率，会同时变化。使用数学模拟模型估计了一系列现有和假设的宫颈癌筛查项目的成本和效果。基于这些估计，计算了一系列项目的每生命年平均成本和每生命年边际成本。这些计算结果确定了一系列低效项目。此外，研究表明，随着项目通过缩短筛查间隔或扩大目标人群范围以涵盖非常年轻和/或非常年老的人群而强化，有效筛查项目的成本效益会以越来越快的速度下降。本文的结论是，宫颈癌筛查项目可能不应超出每4年对25至59岁年龄组女性进行筛查的范围。此外，提高该群体的参与率是增加获得的生命年数的更具成本效益的方式，而不是扩大目标群体或缩短筛查间隔。
