West China School of Public Health and West Fourth Hospital, Sichuan University, Chengdu, China.
Department of Molecular Epidemiology, Shenzhen Center for Disease Control and Prevention, Shenzhen,China.
Asian Pac J Cancer Prev. 2020 May 1;21(5):1317-1325. doi: 10.31557/APJCP.2020.21.5.1317.
Cervical cancer is preventable and curable by detected early and managed effectively. To explore the most economical and effective cervical cancer screening strategies would lay a solid foundation for reducing the health and economic burden of cervical cancer.
A Markov model was established for a cohort of 100,000 female to simulate the natural history of cervical cancer. 18 screening strategies were estimated including careHPV, Thin prep cytologic (TCT), Visual inspection with acetic acid/ Lugol's iodine (VIA / VILI), careHPV in series with VIA / VILI, careHPV in series with TCT, three methods parallel connection every 1, 3, 5 years respectively. Model outcomes included cumulative risk of incidence and death of cervical cancer, quality-adjusted life years (QALYs), cost-effectiveness ratios (CERs), incremental cost-effectiveness ratios (ICERs), cost-utility ratios (CURs) and benefits.
According to the results of epidemiological analysis, careHPV similar to the parallel connection every 1 year achieved highest epidemiological effects via reducing the cumulative risk of onset and death by more than 98 %. In health-economic terms, CER among all the screening strategies ranged from -756.34 to 113040.3 Yuan per year and CUR ranged from -169.91 to 11968.27 Yuan per QALY. The benefit ranged from -1629 to 996 Yuan. The incremental cost-effectiveness analysis showed that three methods in parallel every 1 year, TCT every 1 year, VIA/VILI every 1, 3, 5 years and careHPV every 5 years were dominant strategies.
Considering the economic and health benefits of all the strategies, our results suggested careHPV every 3 or 5 years and VIA/VILI every 1 or 3 years eventually were more appropriate as screening methods in rural China.
宫颈癌通过早期发现和有效管理是可预防和可治疗的。探索最经济有效的宫颈癌筛查策略将为降低宫颈癌的健康和经济负担奠定坚实基础。
建立了一个包含 100,000 名女性的队列的马尔可夫模型，以模拟宫颈癌的自然史。评估了 18 种筛查策略，包括 careHPV、液基薄层细胞学检查（TCT）、醋酸/碘液肉眼观察（VIA/VILI）、careHPV 与 VIA/VILI 串联、careHPV 与 TCT 串联、三种方法分别每 1、3、5 年并行连接。模型结果包括宫颈癌发病和死亡的累积风险、质量调整生命年（QALYs）、成本效益比（CER）、增量成本效益比（ICER）、成本效用比（CUR）和效益。
根据流行病学分析结果，careHPV 与每年并行连接 1 年的方案相似，通过降低发病和死亡的累积风险超过 98%，达到最高的流行病学效果。在健康经济学方面，所有筛查策略的 CER 范围为-756.34 至 113040.3 元/年，CUR 范围为-169.91 至 11968.27 元/QALY。效益范围为-1629 至 996 元。增量成本效益分析表明，三种方法每年并行 1 年、TCT 每年 1 年、VIA/VILI 每年 1、3、5 年和 careHPV 每 5 年是主导策略。
考虑到所有策略的经济和健康效益，我们的结果表明，careHPV 每 3 或 5 年和 VIA/VILI 每年 1 或 3 年是中国农村更合适的筛查方法。
