Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA.
Basic Health International, Colonia San Francisco, San Salvador, El Salvador.
Int J Gynaecol Obstet. 2019 Apr;145(1):40-46. doi: 10.1002/ijgo.12773.
To assess the cost-effectiveness of HPV-based screening and management algorithms for HPV-positive women in phase 2 of the Cervical Cancer Prevention in El Salvador (CAPE) demonstration, relative to the status quo of Pap-based screening.
Data from phase 2 of the CAPE demonstration (n=8000 women) were used to inform a mathematical model of HPV infection and cervical cancer. The model was used to project the lifetime health and economic outcomes of HPV testing every 5 years (age 30-65 years), with referral to colposcopy for HPV-positive women; HPV testing every 5 years (age 30-65 years), with immediate cryotherapy for eligible HPV-positive women; and Pap testing every 2 years (age 20-65 years), with referral to colposcopy for Pap-positive women.
Despite slight decreases in the proportion of HPV-positive women who received treatment relative to phase 1, the health impact of screening in phase 2 remained stable, reducing cancer risk by 58.5%. As in phase 1, HPV testing followed by cryotherapy for eligible HPV-positive women remained the least costly and most effective strategy (US$490 per year of life saved).
HPV-based screening followed by immediate cryotherapy in all eligible women would be very cost-effective in El Salvador.
评估基于 HPV 的筛查和管理算法在萨尔瓦多宫颈癌预防（CAPE）示范项目第 2 阶段中对 HPV 阳性女性的成本效益，与基于巴氏涂片的筛查现状相比。
使用 CAPE 示范项目第 2 阶段的数据（n=8000 名女性）为 HPV 感染和宫颈癌的数学模型提供信息。该模型用于预测 HPV 检测（年龄 30-65 岁，每 5 年一次）、HPV 阳性女性转诊行阴道镜检查、HPV 阳性女性立即行冷冻治疗（年龄 30-65 岁，每 5 年一次）和巴氏涂片检测（年龄 20-65 岁，巴氏涂片阳性女性转诊行阴道镜检查）的终身健康和经济结果。
尽管与第 1 阶段相比，接受治疗的 HPV 阳性女性比例略有下降，但第 2 阶段筛查的健康影响保持稳定，降低了 58.5%的癌症风险。与第 1 阶段一样，HPV 检测后对符合条件的 HPV 阳性女性进行冷冻治疗仍然是成本效益最高的策略（每年每挽救 1 年生命的成本为 490 美元）。
在萨尔瓦多，对所有符合条件的女性进行基于 HPV 的筛查并立即进行冷冻治疗将非常具有成本效益。
