Adelaide Dental School, Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, Australia.
Cancer Council of NSW, Sydney, Australia.
PLoS One. 2021 Jul 22;16(7):e0254575. doi: 10.1371/journal.pone.0254575. eCollection 2021.
Working in partnership with Indigenous communities in South Australia, we aimed to develop, pilot test and estimate utility scores for health states relating to cervical cancer screening, precancer, and invasive cervical cancer and precancer/cancer treatment among Indigenous women.
Development and pilot testing of hypothetical cervical cancer health states, specifically through the lens of being an Indigenous Australian woman, was done with an Indigenous Reference Group in conjunction with five female Indigenous community members. Six health states were developed. These included: (1) Screened: cytology normal; (2) human papillomaviruses (HPV) positive with cytology normal; (3) low grade cytology (LSIL);(4) high grade cytology (HSIL); (5) early stage cervical cancer and; (6) later stage cervical cancer. Utility scores were calculated using a two-stage standard gamble approach among a large cohort of Indigenous Australian women taking part in a broader study involving oral HPV infection. The mean and standard deviation (SD) of the rank, percentage of respondents with a utility = 1 (perfect health) and utility score of each health state was summarised. Mean (SD) and medians and inter-quartile range (IQR) over 12 months and lifetime duration were calculated. Potential differences by age and residential location were assessed using the Wilcox Sum Rank test.
Data was obtained from 513 Indigenous women aged 19+ years. Mean utility scores were higher for the four non-cancer health states than for invasive cervical cancer states (p-values <0.05). Lower mean utility scores were observed for late stage cervical cancer, with 0.69 at 12 months and 0.70 for lifetime duration (Intra-class correlation coefficients = 0.425). Higher utility scores were observed for the four non-cancer health states among non-metropolitan participants (ranged from 0.93 to 0.98) compared with metropolitan participants (ranged from 0.86 to 0.93) (p-values<0.05).
Among a large cohort of Indigenous Australian women, the reduction in quality of life (which utilities reflect) was perceived to be greater with increasing severity of cervical cancer health states. There were differences observed by geographic location, with positive cervical screening and precursor cancer-related quality of life being much higher among non-metropolitan-dwelling participants. These utility values, from one of the largest such studies ever performed in any population will be uniquely able to inform modelled evaluations of the benefits and costs of cervical cancer prevention interventions in Indigenous women.
与南澳大利亚的土著社区合作，我们旨在开发、试点测试并估算与宫颈癌筛查、癌前病变以及土著妇女的浸润性宫颈癌和癌前病变/癌症治疗相关的健康状况的效用评分。
通过土著参考小组与五名土著社区成员合作，对假设的宫颈癌健康状况进行了开发和试点测试，这些测试特别从澳大利亚土著妇女的角度进行。开发了六个健康状况：（1）筛查：细胞学正常；（2）人乳头瘤病毒（HPV）阳性且细胞学正常；（3）低度细胞学异常（LSIL）；（4）高度细胞学异常（HSIL）；（5）早期宫颈癌；（6）晚期宫颈癌。在参与更广泛的口腔 HPV 感染研究的大量土著澳大利亚女性中，使用两阶段标准博弈法计算了效用评分。总结了每个健康状况的平均（SD）和排名的标准偏差（SD）、表示效用=1（完全健康）的受访者百分比以及效用评分。计算了 12 个月和终身期间的平均值（SD）和中位数以及四分位距（IQR）。使用 Wilcox 总和秩检验评估了年龄和居住地点的潜在差异。
从 513 名 19 岁及以上的土著妇女中获得了数据。四个非癌症健康状况的平均效用评分高于浸润性宫颈癌状态（p 值<0.05）。晚期宫颈癌的平均效用评分较低，12 个月时为 0.69，终身为 0.70（类内相关系数=0.425）。非大都市参与者的四个非癌症健康状况的效用评分较高（范围为 0.93 至 0.98），而大都市参与者的效用评分较低（范围为 0.86 至 0.93）（p 值<0.05）。
在大量土著澳大利亚女性中，随着宫颈癌健康状况的严重程度增加，生活质量（效用反映）的下降被认为更大。观察到地理位置的差异，非大都市居民的阳性宫颈筛查和癌前病变相关生活质量要高得多。这些效用值来自于任何人群中进行的此类最大规模研究之一，将能够独特地为土著妇女宫颈癌预防干预措施的效益和成本的建模评估提供信息。
