Ko Min Jung, Kim Jimin, Kim Younhee, Lee Yoon Jae, Hong Sung Ran, Lee Jae Kwan
Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea E-mail :
Asian Pac J Cancer Prev. 2015;16(6):2317-22. doi: 10.7314/apjcp.2015.16.6.2317.
Despite the increasing number of screening examinations performed for cervical cancer utilizing the Papanicolaou smear test (Pap test), few studies have examined whether this strategy is cost-effective in Korea.
This study was conducted to evaluate the cost-effectiveness of cervical cancer screening strategies incorporating the Pap test based on age at the start and end of screening as well as screening interval.
We designed four alternative screening strategies based on patient age when screening was started (20 or 30 years) and discontinued (lifetime, 79 years). Each strategy was assessed at screening intervals of 1, 2, 3, or 5 years. A Markov model was developed to determine the cost-effectiveness of the 16 possible cervical cancer screening strategies, and this was evaluated from a societal perspective. The main outcome measures were average lifetime cost, incremental quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER).
Compared with various strategies comprising younger starting age, discontinuation age, and longer screening intervals, strategies employing annual screening for cervical cancer starting at a target age of 30 years and above were the most cost-effective, with an ICER of 21,012.98 dollars per QALY gained (with a Korean threshold of 30,000,000 KRW or US$27,272).
We found that annual screening for cervical cancer beginning at a target age of 30 years and above is most cost-effective screening strategy. Considering the potential economic advantages, more intense screening policies for cervical cancer might be favorable among countries with high rates of cervical cancer and relatively low screening costs.
尽管利用巴氏涂片检查（Pap 检测）进行宫颈癌筛查的检查数量不断增加，但很少有研究探讨这种策略在韩国是否具有成本效益。
本研究旨在评估基于筛查开始和结束时的年龄以及筛查间隔纳入 Pap 检测的宫颈癌筛查策略的成本效益。
我们根据开始筛查时的患者年龄（20 岁或 30 岁）和停止筛查时的年龄（终身，79 岁）设计了四种替代筛查策略。每种策略在 1 年、2 年、3 年或 5 年的筛查间隔下进行评估。开发了一个马尔可夫模型来确定 16 种可能的宫颈癌筛查策略的成本效益，并从社会角度进行评估。主要结局指标为平均终身成本、增量质量调整生命年（QALY）和增量成本效益比（ICER）。
与包括较低起始年龄、终止年龄和较长筛查间隔的各种策略相比，从 30 岁及以上目标年龄开始每年进行宫颈癌筛查的策略成本效益最高，每获得一个 QALY 的 ICER 为 21,012.98 美元（韩国阈值为 30,000,000 韩元或 27,272 美元）。
我们发现从 30 岁及以上目标年龄开始每年进行宫颈癌筛查是最具成本效益的筛查策略。考虑到潜在的经济优势，对于宫颈癌发病率高且筛查成本相对较低的国家，更严格的宫颈癌筛查政策可能是有利的。
