National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Pan-jia-yuan South Lane, Chaoyang District, Beijing, 100021, China.
Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland.
BMC Med. 2021 Mar 3;19(1):62. doi: 10.1186/s12916-021-01930-9.
The World Health Assembly has adopted a global strategy to eliminate cervical cancer. However, neither the optimal pathway nor the corresponding economic and health benefits have been evaluated. We take China as an example to assess the optimal pathway towards elimination and the cost-effectiveness of tailored actions.
A validated hybrid model was used to assess the costs and benefits of alternative strategies combining human papillomavirus vaccination, cervical screening, and treatment of pre-invasive lesions and invasive cancer for females with different immunization history. All Chinese females living or projected to be born during 2015-2100, under projected trends in aging, urbanization, and sexual activity, were considered. Optimal strategies were determined by cost-effectiveness efficiency frontiers. Primary outcomes were cervical cancer cases and deaths averted and incremental cost-effectiveness ratios (ICERs). We employed a lifetime horizon from a societal perspective. One-way and probabilistic sensitivity analyses evaluate model uncertainty.
The optimal pathway represents an integration of multiple tailored strategies from females with different immunization history. If China adopts the optimal pathway, the age-standardized incidence of cervical cancer is predicted to decrease to fewer than four new cases per 100,000 women (i.e., elimination) by 2047 (95% confidence interval 2043 to 2050). Compared to the status quo, the optimal pathway would avert a total of 7,509,192 (6,922,744 to 8,359,074) cervical cancer cases and 2,529,873 (2,366,826 to 2,802,604) cervical cancer deaths in 2021-2100, with the discounted ICER being $- 339 (- 687 to - 79) per quality-adjusted life-year.
By adopting an optimal pathway from 2021 (namely, the year of the first Chinese Centennial Goals) onwards, cervical cancer could be eliminated by the late 2040s (namely, ahead of the second Chinese Centennial Goals) while saving net economic costs in China.
世界卫生大会已通过一项全球战略，以消除宫颈癌。然而，目前尚未评估最佳途径以及相应的经济和健康效益。我们以中国为例，评估消除宫颈癌的最佳途径以及针对特定人群采取措施的成本效益。
采用经过验证的混合模型，评估不同免疫史女性人群中，人乳头瘤病毒（HPV）疫苗接种、宫颈筛查以及治疗癌前病变和浸润性宫颈癌相结合的各种替代策略的成本和效益。考虑了所有 2015 年至 2100 年期间居住或预计出生的中国女性，以及老龄化、城市化和性行为的预期趋势。通过成本效益效率边界确定最佳策略。主要结局是宫颈癌病例和死亡人数的减少以及增量成本效益比（ICER）。我们从社会角度考虑了终生时间范围。采用单因素敏感性分析和概率敏感性分析来评估模型不确定性。
最佳途径代表了来自不同免疫史女性的多种针对性策略的整合。如果中国采用最佳途径，到 2047 年（95%置信区间 2043 年至 2050 年），宫颈癌的年龄标准化发病率预计将降至每 10 万名妇女不到 4 例（即消除）。与现状相比，最佳途径将总共避免 7509192 例（2366826 例至 2802604 例）宫颈癌病例和 2529873 例（2529873 例至 2802604 例）宫颈癌死亡，经贴现后的 ICER 为每获得一个质量调整生命年节约 339 美元（-687 美元至-79 美元）。
从 2021 年（即中国第一个百年目标的第一年）开始采用最佳途径，到 2040 年代末（即第二个百年目标之前），中国可以消除宫颈癌，同时节省净经济成本。
