Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
Departments of Pathology and Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA.
Prev Med. 2018 Jun;111:177-179. doi: 10.1016/j.ypmed.2018.03.011. Epub 2018 Mar 14.
There is limited information on the cost-inefficiencies of non-adherence to recommended cervical cancer screening or the potential value for improving non-adherence. We estimated the incremental value of adhering to recommended screening every three years with cytology, using a disease simulation model that integrated real-world screening practice data from New Mexico. The amount that can be spent to improve adherence was estimated by calculating the incremental net monetary benefit (INMB) under scenarios of Current Practice (assuming a population of mixed adherence) and Uniformly Non-Adherent populations with imperfect or perfect adherence to follow-up of screen-positive women. Getting unscreened women screened every three years by cytology was a better value than increasing screening in the under-screened or reducing screening in the over-screened. For example, INMBs were $3998 for screening previously unscreened women versus $136 for eliminating annual screening at a willingness-to-pay threshold of $100,000 per quality-adjusted life-year gained. Strategies to reach unscreened women are potentially high-value investments.
关于不遵守推荐的宫颈癌筛查的成本效率或改善不遵守的潜在价值的信息有限。我们使用一种疾病模拟模型，该模型整合了新墨西哥州的真实筛查实践数据，估计了每三年通过细胞学检查坚持推荐筛查的增量价值。通过计算当前实践（假设混合依从性人群）和完全不依从随访的人群（对筛查阳性女性的依从性不完全或完全）的增量净货币收益（INMB），可以估计出提高依从性的花费。通过细胞学检查让未筛查的女性每三年接受一次筛查，比增加筛查不足或减少过度筛查的价值更高。例如，在愿意支付每获得一个质量调整生命年 10 万美元的阈值下，对以前未筛查的女性进行筛查的增量净货币收益为 3998 美元，而消除每年筛查的增量净货币收益为 136 美元。针对未筛查女性的策略可能是高价值的投资。
