Anderson Rob, Haas Marion, Shanahan Marian
Peninsula Technology Assessment Group (PenTAG) and Institute for Health Services Research, Peninsula Medical School, Universities of Exeter and Plymouth, United Kingdom.
Aust N Z J Public Health. 2008 Feb;32(1):43-52. doi: 10.1111/j.1753-6405.2008.00165.x.
To estimate the cost-effectiveness of altering the currently recommended interval and age range for cervical screening of Australian women.
The cost and effectiveness estimates of alternative screening strategies were generated using an established decision model. This model incorporated a Markov model (of the natural history of cervical cancer and pre-cancerous lesions) and decision trees which: 'mapped' the various pathways to cervical cancer screening; the follow-up of abnormal Pap test results; and the management of confirmed lesions. The model simulated a hypothetical large cohort of Australian women from age 15 to age 85 and calculated the accumulated costs and life-years under each screening strategy.
Our model estimated that moving from the current two-yearly screening strategy to annual screening (over the same age range) would cost $379,300 per additional life-year saved. Moving from the current strategy to three-yearly screening would yield $117,100 of savings per life-year lost (costs and effects both discounted at 5% per year), with a relatively modest (<5%) reduction in the total number of life-years saved by the program.
Although moving to annual screening would save some additional lives, it is not a cost-effective strategy. Consideration should be given to increasing the recommended interval for cervical screening. However, the net value of any such shift to less effective (e.g. less frequent) and less costly screening strategies will require better evidence about the cost-effectiveness of strategies that encourage non-screeners or irregular screeners to have a Pap test more regularly.
评估改变澳大利亚女性宫颈癌筛查当前推荐间隔和年龄范围的成本效益。
使用既定的决策模型生成替代筛查策略的成本和效益估计值。该模型纳入了一个马尔可夫模型（关于宫颈癌和癌前病变的自然史）以及决策树，这些决策树“描绘”了宫颈癌筛查的各种途径、异常巴氏试验结果的随访以及确诊病变的管理。该模型模拟了一个假设的从15岁到85岁的澳大利亚女性大群体，并计算了每种筛查策略下的累计成本和生命年数。
我们的模型估计，从当前每两年一次的筛查策略改为每年一次筛查（在相同年龄范围内），每多挽救一个生命年将花费379,300美元。从当前策略改为每三年一次筛查，每损失一个生命年将节省117,100美元（成本和效益均按每年5%贴现），该项目挽救的生命年总数相对适度减少（<5%）。
尽管改为每年一次筛查会挽救一些额外生命，但这不是一种具有成本效益的策略。应考虑增加宫颈癌筛查的推荐间隔。然而，向效果较差（如筛查频率较低）且成本较低的筛查策略转变的净值，将需要关于鼓励未筛查者或不定期筛查者更定期进行巴氏试验的策略的成本效益的更好证据。
