Viscondi Juliana Yukari Kodaira, Faustino Christine Grutzmann, Campolina Alessandro Gonçalves, Itria Alexander, Soárez Patricia Coelho de
Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR.
Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
Clinics (Sao Paulo). 2018 Jul 10;73:e385. doi: 10.6061/clinics/2018/e385.
The aim of this study was to critically evaluate the quality of the models used in economic evaluations of screening strategies for cervical cancer prevention. We systematically searched multiple databases, selecting model-based full economic evaluations (cost-effectiveness analyses, cost-utility analyses, and cost-benefit analyses) of cervical cancer screening strategies. Two independent reviewers screened articles for relevance and performed data extraction. Methodological assessment of the quality of the models utilized formal checklists, and a qualitative narrative synthesis was performed. Thirty-eight articles were reviewed. The majority of the studies were conducted in high-income countries (82%, n=31). The Pap test was the most used screening strategy investigated, which was present in 86% (n=33) of the studies. Half of the studies (n=19) used a previously published Markov model. The deterministic sensitivity analysis was performed in 92% (n=35) of the studies. The mean number of properly reported checklist items was 9 out of the maximum possible 18. Items that were better reported included the statement of decision problem, the description of the strategies/comparators, the statement of time horizon, and information regarding the disease states. Compliance with some items of the checklist was poor. The Markov models for economic evaluation of screening strategies for cervical cancer varied in quality. The following points require improvement: 1) assessment of methodological, structural, heterogeneity, and parameter uncertainties; 2) model type and cycle length justification; 3) methods to account for heterogeneity; and 4) report of consistency evaluation (through calibration and validation methods).
本研究的目的是严格评估用于宫颈癌预防筛查策略经济评估的模型质量。我们系统地检索了多个数据库，选择了基于模型的宫颈癌筛查策略全面经济评估（成本效益分析、成本效用分析和成本效益分析）。两名独立评审员筛选文章的相关性并进行数据提取。利用正式清单对模型质量进行方法学评估，并进行定性叙述性综合分析。共审查了38篇文章。大多数研究在高收入国家进行（82%，n = 31）。巴氏试验是研究中使用最多的筛查策略，86%（n = 33）的研究中都有该策略。一半的研究（n = 19）使用了先前发表的马尔可夫模型。92%（n = 35）的研究进行了确定性敏感性分析。在可能的最多18项清单项目中，平均正确报告的项目数为9项。报告较好的项目包括决策问题陈述、策略/对照的描述、时间范围陈述以及疾病状态信息。清单某些项目的合规性较差。用于宫颈癌筛查策略经济评估的马尔可夫模型质量参差不齐。以下几点需要改进：1）方法学、结构、异质性和参数不确定性评估；2）模型类型和周期长度的合理性说明；3）考虑异质性的方法；4）一致性评估报告（通过校准和验证方法）。
