Kulasingam Shalini L, Myers Evan R, Lawson Herschel W, McConnell K John, Kerlikowske Karla, Melnikow Joy, Washington A Eugene, Sawaya George F
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA.
Obstet Gynecol. 2006 Feb;107(2 Pt 1):321-8. doi: 10.1097/01.AOG.0000196500.50044.ce.
Annual cervical cancer screening in women with many prior normal Pap tests is common despite limited evidence on the cost-effectiveness of this strategy. We estimated the cost-effectiveness of screening women with 3 or more prior normal tests compared with screening those with no prior tests.
We used a validated cost-effectiveness model in conjunction with data on the prevalence of biopsy-proven cervical neoplasia in women enrolled in the Centers for Disease Control and Prevention National Breast and Cervical Cancer Early Detection Program. Women were grouped according to age at the final Program Pap test (aged < 30, 30-44, 45-59, and 60-65 years) and by screening history (0, 1, 2, and 3+ consecutive prior normal Program tests) to estimate cost per life-year and quality-adjusted life-year associated with annual, biennial, and triennial screening.
For women aged 30-44 years with no prior tests, incremental cost-effectiveness ratios ranged from 20,533 US dollars for screening triennially (compared with no further screening) to 331,837 US dollars for screening annually (compared with biennially) per life-year saved. Among same-aged women with 3 or more prior normal Program tests, incremental cost-effectiveness ratios for the same measures ranged from 60,029 US dollars to 709,067 US dollars per life-year saved. Inclusion of the most conservative utility estimates resulted in incremental cost-effectiveness ratios in excess of 100,000 US dollars per quality-adjusted life-year saved associated with annual screening of same-aged women with 3 or more prior normal tests compared with biennial screening.
As the number of prior normal Pap tests increases, the costs per life-year saved increase substantially. Resources should be prioritized for screening those never or rarely screened women.
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尽管对于多次巴氏试验结果正常的女性进行年度宫颈癌筛查这一策略的成本效益证据有限，但这种筛查方式仍很常见。我们评估了对有3次或更多次既往巴氏试验结果正常的女性进行筛查与对无既往筛查史的女性进行筛查相比的成本效益。
我们使用了一个经过验证的成本效益模型，并结合了疾病控制与预防中心国家乳腺癌和宫颈癌早期检测项目中经活检证实的宫颈肿瘤女性患病率的数据。根据最后一次项目巴氏试验时的年龄（小于30岁、30 - 44岁、45 - 59岁和60 - 65岁）以及筛查史（0次、1次、2次和3次及以上连续既往项目试验结果正常）对女性进行分组，以估计与每年、每两年和每三年筛查相关的每生命年成本和质量调整生命年。
对于年龄在30 - 44岁且无既往筛查史的女性，每挽救一个生命年的增量成本效益比范围为每三年筛查（与不再进一步筛查相比）20,533美元至每年筛查（与每两年筛查相比）331,837美元。在年龄相同且有3次或更多次既往项目试验结果正常的女性中，相同措施的每挽救一个生命年的增量成本效益比范围为60,029美元至709,067美元。纳入最保守的效用估计值后，与每两年筛查相比，对年龄相同且有3次或更多次既往项目试验结果正常的女性进行年度筛查，每挽救一个质量调整生命年的增量成本效益比超过100,000美元。
随着既往巴氏试验结果正常次数的增加，每挽救一个生命年的成本大幅增加。应优先将资源用于筛查从未或很少接受筛查的女性。
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