Peng J R, Tao S Y, Wen Y, Yang X, Ma J Q, Zhao F, Chen Z Y, Zhang G T, Qiao Y L, Zhao F H, Yang C X
Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu 610041, China.
Key Laboratory of Molecular Biology of Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China.
Zhonghua Zhong Liu Za Zhi. 2019 Feb 23;41(2):154-160. doi: 10.3760/cma.j.issn.0253-3766.2019.02.015.
To explore the most economically feasible cervical cancer screening strategies in urban China. A series of Markov models were constructed to evaluate health and economic outcomes of different screening strategies. There were 24 screening strategies including four screening methods: liquid-based cytology (LBC), human papillomavirus (HPV) DNA genotyping, HPV DNA genotyping with LBC triage (HPV DNA+ LBC), HPV DNA genotyping and LBC co-testing (HPV DNA-LBC), along with three intervals (every 1, 3 or 5 years) and two starting age for screening (30 or 35 years old) were compared. Models parameters were obtained from a cervical cancer screening study in urban China and literature reviews. The cumulative incidence and mortality risk of cervical cancer declined over 69% and 82% respectively for each screening strategy as compared with the no screening scenario. LBC every five years starting from 35 years old strategy cost the least (RMB 690 per capita) and could save life years compared with no screening. The cost effectiveness ratios of 24 strategies ranged from -10 903 to 117 992 RMB per life year saved. All strategies were cost-effective compared to no screening. In the incremental cost-effectiveness analysis, LBC every 5 years starting from 30 strategy, HPV DNA genotyping every 3 years starting from 30 strategy, LBC every 3 years starting from 30 strategy and LBC every year starting from 30 strategy were dominant strategies. Screening can effectively prevent cervical cancer. In urban Chinese areas with insufficient socioeconomic resources, LBC every 5 years from 35 years old strategy is recommended. In relatively more affluent areas, LBC every 5 years from 30 years old strategy, LBC every 3 years from 30 years old strategy, HPV DNA genotyping every 3 years from 30 years old strategy, and LBC every year from 30 years old strategy are recommended successively.
为探索中国城市地区最具经济可行性的宫颈癌筛查策略。构建了一系列马尔可夫模型来评估不同筛查策略的健康和经济结果。共有24种筛查策略，包括四种筛查方法：液基细胞学检查（LBC）、人乳头瘤病毒（HPV）DNA基因分型、HPV DNA基因分型联合LBC分流（HPV DNA+LBC）、HPV DNA基因分型与LBC联合检测（HPV DNA-LBC），同时比较了三种筛查间隔（每1、3或5年）和两个筛查起始年龄（30或35岁）。模型参数取自中国城市地区的一项宫颈癌筛查研究及文献综述。与未筛查方案相比，每种筛查策略的宫颈癌累积发病率和死亡风险分别下降了69%以上和82%以上。从35岁开始每五年进行一次LBC筛查策略成本最低（人均690元人民币），与未筛查相比可节省生命年。24种策略的成本效益比为每挽救一个生命年-10903至117992元人民币。与未筛查相比，所有策略均具有成本效益。在增量成本效益分析中，从30岁开始每5年进行一次LBC筛查策略、从30岁开始每3年进行一次HPV DNA基因分型筛查策略、从30岁开始每3年进行一次LBC筛查策略以及从30岁开始每年进行一次LBC筛查策略为优势策略。筛查可有效预防宫颈癌。在中国城市社会经济资源不足的地区，建议从35岁开始每5年进行一次LBC筛查策略。在相对富裕地区，依次推荐从30岁开始每5年进行一次LBC筛查策略、从30岁开始每3年进行一次LBC筛查策略、从30岁开始每3年进行一次HPV DNA基因分型筛查策略以及从30岁开始每年进行一次LBC筛查策略。
