Mezei Alex K, Armstrong Heather L, Pedersen Heather N, Campos Nicole G, Mitchell Sheona M, Sekikubo Musa, Byamugisha Josaphat K, Kim Jane J, Bryan Stirling, Ogilvie Gina S
Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Women's Health Research Institute, BC Women's Hospital, Vancouver, BC, Canada.
Int J Cancer. 2017 Aug 1;141(3):437-446. doi: 10.1002/ijc.30695. Epub 2017 Apr 3.
The incidence of cervical cancer in low- and middle-income countries (LMICs) is five times higher than that observed in high-income countries (HICs). This discrepancy is largely attributed to the implementation of cytology-based screening programmes in HICs. However, due to reduced health system infrastructure requirements, HPV testing (self- and provider-collected) and visual inspection with acetic acid (VIA) have been proposed as alternatives that may be better suited to LMICs. Knowing the relative value of different screening options can inform policy and the development of sustainable prevention programs. We searched MEDLINE and EMBASE for English language publications detailing model-based cost-effectiveness analyses of cervical cancer screening methods in LMICs from 2000 to 2016. The main outcome of interest was the incremental cost-effectiveness ratio (ICER). Quantitative data were extracted to compare commonly evaluated screening methods and a descriptive review was conducted for each included study. Of the initial 152 articles reviewed, 19 met inclusion criteria. Generally, cytology-based screening was shown to be the least effective and most costly screening method. Whether provider-collected HPV testing or VIA was the more efficient alternative depended on the cost of the HPV test, loss to follow-up and VIA test performance. Self-collected HPV testing was cost-effective when it yielded population coverage gains over other screening methods. We conclude that HPV testing and VIA are more cost-effective screening methods than cytology in LMICs. Policy makers should consider HPV testing with self-collection of samples if it yields gains in population coverage.
低收入和中等收入国家（LMICs）宫颈癌的发病率比高收入国家（HICs）高出五倍。这种差异很大程度上归因于高收入国家实施的基于细胞学的筛查计划。然而，由于对卫生系统基础设施的要求较低，人乳头瘤病毒检测（自我采集和医护人员采集）以及醋酸目视检查（VIA）已被提议作为可能更适合低收入和中等收入国家的替代方法。了解不同筛查选项的相对价值可为政策制定和可持续预防计划的制定提供参考。我们检索了MEDLINE和EMBASE，查找2000年至2016年期间详细介绍低收入和中等收入国家宫颈癌筛查方法基于模型的成本效益分析的英文出版物。主要关注的结果是增量成本效益比（ICER）。提取定量数据以比较常用的评估筛查方法，并对每项纳入研究进行描述性综述。在最初审查的152篇文章中，有19篇符合纳入标准。一般来说，基于细胞学的筛查被证明是最无效且成本最高的筛查方法。医护人员采集的人乳头瘤病毒检测还是醋酸目视检查是更有效的替代方法，取决于人乳头瘤病毒检测的成本、失访情况和醋酸目视检查的检测性能。当自我采集的人乳头瘤病毒检测在人群覆盖率方面超过其他筛查方法时，它具有成本效益。我们得出结论，在低收入和中等收入国家，人乳头瘤病毒检测和醋酸目视检查比细胞学筛查更具成本效益。如果自我采集样本的人乳头瘤病毒检测能提高人群覆盖率，政策制定者应予以考虑。
