Burger Emily A, Kim Jane J
Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
Int J Cancer. 2014 Oct 15;135(8):1931-9. doi: 10.1002/ijc.28838. Epub 2014 Mar 20.
Failures in cervical cancer (CC) screening include nonparticipation, underscreening and loss to follow-up of abnormal results. We estimated the long-term health benefits from and maximum investments in interventions targeted to improving compliance to guidelines while remaining cost-effective. We used a mathematical model empirically calibrated to simulate the natural history of CC in Norway. A baseline scenario reflecting current practice using cytology-based screening was compared to scenarios that target different sources of noncompliance: (i) failure to follow-up women with abnormal results, (ii) screening less frequently than recommended (i.e., underscreening) and (iii) absence of screening. A secondary analysis included human papillomavirus (HPV)-based screening as the primary test. Model outcomes included reductions in lifetime cancer risk and incremental net monetary benefit (INMB) resulting from improvements with compliance. Compared to the status quo, improving all sources of noncompliance leads to important health gains and produced positive INMBs across a range of developed-country willingness-to-pay (WTP) thresholds. For example, a 2% increase in compliance could reduce lifetime cancer risk by 1-3%, depending on the targeted source of noncompliance and primary screening method. Assuming a WTP threshold of $83,000 per year of life saved and cytology-based screening, interventions that increase follow-up of abnormal results yielded the highest INMB per 2% increase in coverage [$19 ($10-21)]. With HPV-based screening, recruiting nonscreeners resulted in the largest INMB [$23 ($18-32)]. Considerable funds could be allocated toward policies that improve compliance with screening under the current cytology-based program or toward adoption of primary HPV-based screening while remaining cost-effective.
宫颈癌（CC）筛查失败包括未参与、筛查不足以及异常结果失访。我们估算了针对提高指南依从性的干预措施所带来的长期健康益处以及最大投资额，同时保持成本效益。我们使用了一个经过实证校准的数学模型来模拟挪威宫颈癌的自然史。将反映当前基于细胞学筛查实践的基线情景与针对不同不依从来源的情景进行比较：（i）对异常结果女性未进行随访；（ii）筛查频率低于推荐频率（即筛查不足）；（iii）未进行筛查。二次分析包括将基于人乳头瘤病毒（HPV）的筛查作为主要检测方法。模型结果包括因依从性改善而导致的终身癌症风险降低以及增量净货币效益（INMB）。与现状相比，改善所有不依从来源可带来重要的健康收益，并在一系列发达国家支付意愿（WTP）阈值范围内产生正的INMB。例如，依从性提高2%可使终身癌症风险降低1%-3%，这取决于目标不依从来源和主要筛查方法。假设每挽救一年生命的WTP阈值为83,000美元且采用基于细胞学的筛查，每覆盖增加2%，增加对异常结果随访的干预措施产生的INMB最高[19美元（10-21美元）]。采用基于HPV的筛查时，招募未筛查者产生的INMB最大[23美元（18-32美元）]。在当前基于细胞学的项目下，可将大量资金用于改善筛查依从性的政策，或用于采用基于HPV的主要筛查方法，同时保持成本效益。
