Koopmanschap M A, van Oortmarssen G J, van Agt H M, van Ballegooijen M, Habbema J D, Lubbe K T
Department of Public Health and Social Medicine, Erasmus University, Rotterdam, The Netherlands.
Int J Cancer. 1990 Mar 15;45(3):410-5. doi: 10.1002/ijc.2910450305.
The influence of attendance on the health effects and cost-effectiveness of cervical-cancer screening was studied, both for organized screening programmes and for spontaneous screening. The asymmetric distribution of smears among the female population and the higher risk incurred by women who never or only occasionally attend screening appear crucial in determining the health effects of screening. An increase in attendance rate induces a substantial rise in health effects and a less than proportionate rise in costs, thus improving cost-effectiveness. Wider screening coverage, in order to increase the number of life-years saved, is achieved more efficiently by encouraging a greater number of women to attend than by inviting the same number of women to attend more often, i.e., with a shorter interval between successive screens. Spontaneous screening is characterized by high coverage for younger women and low coverage for middle-aged and older women. This leads to a small amount of health effects and poor cost-effectiveness as compared with organized screening.
研究了筛查参与率对宫颈癌筛查的健康效果和成本效益的影响，涉及组织化筛查项目和自发筛查。涂片在女性人群中的不对称分布以及从未或仅偶尔参与筛查的女性所面临的更高风险，在决定筛查的健康效果方面似乎至关重要。参与率的提高会使健康效果大幅提升，而成本的增长幅度则小于比例增幅，从而提高成本效益。为了增加挽救的生命年数，扩大筛查覆盖范围通过鼓励更多女性参与筛查比邀请相同数量的女性更频繁地参与筛查（即连续筛查之间的间隔更短）能更有效地实现。自发筛查的特点是年轻女性覆盖率高，中年及老年女性覆盖率低。与组织化筛查相比，这导致健康效果有限且成本效益不佳。
