Xu He, Zhao Fang-hui, Gao Xiao-hong, Hu Shang-ying, Chen Jun-feng, Liu Zhi-hua, Xu Xiao-ling, Gao Li-min, Liu Qi-gui, Ma Li, Liu Yi-jun, Qiao You-lin
School of Public Health, Dalian Medical University, Dalian 116041, China; Department of Cancer Epidemiology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.
Zhonghua Liu Xing Bing Xue Za Zhi. 2013 Apr;34(4):399-403.
To estimate the cost-effectiveness of once-in-a-lifetime cervical cancer screening program and to predict the optimal modality for its operation on women living in rural and urban areas of China, based on Markov modeling and simulation.
Three modalities including visual inspection with acetic acid plus Lugol's iodine (VIA/VILI), conventional Pap Smear (Pap Smear), and simple HPV DNA testing (careHPV) were hypothesized for the rural cohort, whereas other five modalities including Pap Smear, liquid-based cytology (LBC), simple HPV DNA testing (careHPV), Hybrid Capture 2 HPV DNA testing (HC2), and LBC plus HC2 (LBC + HC2) were tested for the urban cohort. A Markov model was constructed based on the factors as natural history, screening, diagnosis and treatment on cervical cancer using data related to the epidemics and the costs from rural and urban areas of the country. Long-term effectiveness and cost-effectiveness were predicted through simulation of the model.
Compared to the non-screening scenario, the amount of life years saved were 277.97 - 2727.53 and 134.02 - 1446.84 years per 100 000 women, respectively, for different cohorts in rural and urban areas. The cost-effectiveness ratios were 1520.99 - 2453.74 and 3847.35 - 44 570.35 RMB per life year saved, respectively, for different cohorts in rural and urban areas. The incremental cost-effective ratio for careHPV starting from 40 years old (careHPV@40) and careHPV from 30 years old (careHPV@30) dominated other strategies for the rural cohort, while careHPV@40, careHPV@30, HC2 from 30 years old (HC2@30), and LBC + HC2 from 30 years old (LBC + HC2@30) were dominant for the urban cohort.
All eight once-in-a-lifetime cervical cancer screening modalities were cost-effective based on our model. In particular, careHPV screening starting from 40 years old seemed to be the most cost-effective one for women living in both rural and urban areas.
基于马尔可夫模型和模拟，评估一次性宫颈癌筛查项目的成本效益，并预测其在中国农村和城市地区女性中的最佳运作方式。
针对农村人群假设了三种筛查方式，即醋酸染色肉眼观察加卢戈氏碘染色（VIA/VILI）、传统巴氏涂片检查（Pap Smear）和简易人乳头瘤病毒DNA检测（careHPV）；而针对城市人群测试了另外五种筛查方式，包括Pap Smear、液基细胞学检查（LBC）、简易人乳头瘤病毒DNA检测（careHPV）、杂交捕获2人乳头瘤病毒DNA检测（HC2）以及LBC加HC2（LBC + HC2）。利用该国农村和城市地区的流行病数据及成本数据，基于宫颈癌的自然史、筛查、诊断和治疗等因素构建马尔可夫模型。通过对模型的模拟预测长期有效性和成本效益。
与未筛查情况相比，农村和城市地区不同队列每10万名女性分别节省的生命年数为277.97 - 2727.53年和134.02 - 1446.84年。农村和城市地区不同队列每挽救一个生命年的成本效益比分别为1520.99 - 2453.74元和3847.35 - 44570.35元。对于农村队列，40岁开始的careHPV（careHPV@40）和30岁开始的careHPV（careHPV@30）的增量成本效益比优于其他策略；而对于城市队列，careHPV@40、careHPV@30、30岁开始的HC2（HC2@30）和30岁开始的LBC + HC2（LBC + HC2@30）占主导地位。
基于我们的模型，所有八种一次性宫颈癌筛查方式均具有成本效益。特别是，40岁开始的careHPV筛查似乎对农村和城市地区的女性都是最具成本效益的。
