Department of Medical Technology Assessment, Ministry of Health, Ben Tbai 2, San Simone, Jerusalem, Israel.
BMJ. 2012 Mar 2;344:e614. doi: 10.1136/bmj.e614.
To determine the costs and health effects of interventions to combat breast, cervical, and colorectal cancers in order to guide resource allocation decisions in developing countries.
Two World Health Organization sub-regions of the world: countries in sub-Saharan Africa with very high adult and high child mortality (AfrE); and countries in South East Asia with high adult and high child mortality (SearD).
Cost effectiveness analysis of prevention and treatment strategies for breast, cervical, and colorectal cancer, using mathematical modelling based on a lifetime population model.
Demographic and epidemiological data were taken from the WHO mortality and global burden of disease databases. Estimates of intervention coverage, effectiveness, and resource needs were based on clinical trials, treatment guidelines, and expert opinion. Unit costs were taken from the WHO-CHOICE price database.
Cost per disability adjusted life year (DALY) averted, expressed in international dollars ($Int) for the year 2005.
In both regions certain interventions in cervical cancer control (screening through cervical smear tests or visual inspection with acetic acid in combination with treatment) and colorectal cancer control (increasing the coverage of treatment interventions) cost <$Int2000 per DALY averted and can be considered highly cost effective. In the sub-Saharan African region screening for colorectal cancer (by colonoscopy at age 50 in combination with treatment) costs $Int2000-6000 per DALY averted and can be considered cost effective. In both regions certain interventions in breast cancer control (treatment of all cancer stages in combination with mammography screening) cost $Int2000-6000 per DALY averted and can also be considered cost effective. Other interventions, such as campaigns to eat more fruit and vegetable or subsidies in colorectal cancer control, are not cost effective according to the criteria defined.
Highly cost effective interventions to combat cervical and colorectal cancer are available in the African and Asian sub-regions. In cervical cancer control, these include screening through smear tests or visual inspection in combination with treatment. In colorectal cancer, increasing treatment coverage is highly cost effective (screening through colonoscopy is cost effective in the African sub-region). In breast cancer control, mammography screening in combination with treatment of all stages is cost effective.
确定防治乳腺癌、宫颈癌和结直肠癌的干预措施的成本和健康效果，以便为发展中国家的资源分配决策提供指导。
世界卫生组织的两个次区域：撒哈拉以南非洲地区（成人和儿童死亡率极高）和东南亚地区（成人和儿童死亡率高）。
基于终生人群模型，使用数学模型对乳腺癌、宫颈癌和结直肠癌的预防和治疗策略进行成本效益分析。
人口和流行病学数据来自世卫组织死亡率和全球疾病负担数据库。干预措施覆盖率、效果和资源需求的估计基于临床试验、治疗指南和专家意见。单位成本取自世卫组织 CHOICE 价格数据库。
以 2005 年国际元（$Int$）表示的每避免一个伤残调整生命年（DALY）的成本。
在两个地区，某些宫颈癌控制干预措施（通过宫颈涂片检查或醋酸视觉检查与治疗相结合的筛查）和结直肠癌控制干预措施（提高治疗干预措施的覆盖率）的成本低于每避免一个 DALY 的$Int2000$，可被视为极具成本效益。在撒哈拉以南非洲地区，结直肠癌筛查（50 岁时进行结肠镜检查与治疗相结合）的成本为每避免一个 DALY 的$Int2000-6000$，可被视为具有成本效益。在两个地区，某些乳腺癌控制干预措施（所有癌症阶段的治疗与乳房 X 线照片筛查相结合）的成本也低于每避免一个 DALY 的$Int2000-6000$，也可被视为具有成本效益。根据既定标准，其他干预措施，如促进多吃水果和蔬菜的运动或结直肠癌控制补贴，不具有成本效益。
在非洲和亚洲次区域，防治宫颈癌和结直肠癌的高成本效益干预措施是可行的。在宫颈癌控制方面，这些措施包括涂片检查或醋酸视觉检查与治疗相结合的筛查。在结直肠癌方面，提高治疗覆盖率具有极高的成本效益（在非洲次区域，结肠镜筛查具有成本效益）。在乳腺癌控制方面，治疗所有阶段的乳房 X 线照片筛查与治疗相结合具有成本效益。
