Department of Obstetrics and Gynecology, Boston University Medical Center, 85 E. Concord St. 6th Floor, Boston, MA 02118, USA.
Womens Health Issues. 2010 Jan-Feb;20(1):35-42. doi: 10.1016/j.whi.2009.09.001. Epub 2009 Nov 26.
We examined the impact of patient adherence and screening test performance on the cost-effectiveness of visual inspection with acetic acid (VIA) and Pap smears when used with colposcopy for diagnosis.
Cost-effectiveness analysis was performed using computer modeling. The primary outcome was cancer prevalence in the 10 years after screening. Three hypothetical populations of 35-year-old women were compared: never-screened women, women screened with VIA, and women screened with Pap smears. We used community-based data from our screening program in Honduras to estimate screening test sensitivity and specificity, adherence to follow-up, and costs of screening and colposcopy services. Published data were used to model disease outcomes.
VIA was more sensitive than Pap smears (70% vs. 4%), less expensive (U.S. 0.23 dollars vs. 3.17 dollars), and the 2-vist VIA system had a higher rate of adherence to follow-up than the 3-visit Pap smear system (84% vs. 38%). VIA had a higher false-positive rate than Pap smears resulting in higher colposcopy referral rates, but more dysplasia was detected and treated. Cost-effectiveness analysis revealed that screening with VIA would cost U.S. 3,198 dollars per cancer case avoided and reduce cancer cases by 42%, versus U.S. 36,802 dollars and 2% for Pap screening. Although Pap smear quality was low in Honduras, sensitivity analysis showed that VIA was more cost-effective than Pap smears, even when test accuracy was equivalent.
In developing countries, systems barriers can limit the cost-effectiveness of Pap smears. VIA may be a cost-effective alternative for some resource-poor settings, although systems barriers, quality control, and feasibility issues must be considered.
我们研究了患者依从性和筛查试验性能对醋酸视觉检查（VIA）和巴氏涂片与阴道镜检查联合用于诊断时的成本效益的影响。
使用计算机模型进行成本效益分析。主要结果是筛查后 10 年内癌症的患病率。比较了 35 岁女性的三个假设人群：从未筛查的女性、VIA 筛查的女性和巴氏涂片筛查的女性。我们使用来自洪都拉斯筛查计划的基于社区的数据来估计筛查试验的敏感性和特异性、对随访的依从性以及筛查和阴道镜检查服务的成本。使用已发表的数据来模拟疾病结果。
VIA 比巴氏涂片更敏感（70%对 4%），成本更低（0.23 美元对 3.17 美元），并且 2 次就诊的 VIA 系统对随访的依从性高于 3 次就诊的巴氏涂片系统（84%对 38%）。VIA 的假阳性率高于巴氏涂片，导致阴道镜检查转诊率更高，但更多的异型增生被发现并得到治疗。成本效益分析显示，用 VIA 筛查每避免一例癌症的成本为 3198 美元，可减少 42%的癌症病例，而巴氏涂片筛查的成本为 36802 美元，减少 2%。尽管洪都拉斯的巴氏涂片质量较低，但敏感性分析表明，VIA 比巴氏涂片更具成本效益，即使测试准确性相当。
在发展中国家，系统障碍可能会限制巴氏涂片的成本效益。在一些资源匮乏的地区，VIA 可能是一种具有成本效益的替代方法，尽管必须考虑系统障碍、质量控制和可行性问题。
