对筛查不足人群进行高危型人乳头瘤病毒检测：三个国家背景下的成本效益与可负担性

High-risk human papillomavirus testing for underscreened populations: cost-effectiveness and affordability in three country settings.

作者信息

Sultanov Marat, de Bock Geertruida H, Koot Jaap A R, de Zeeuw Janine, Greuter Marcel J W, Pan Fengming, Stekelenburg Jelle, Beltman Jogchum J, de Fouw Marlieke, Nakisige Carolyn, Kabukye Johnblack K, Anecho Ezra, Nazrul Naheed, Kulsum Mosamat U, Rahman Aminur, Majdan Marek, Melichová Juliana, Sokolová Jaroslava, van der Schans Jurjen

机构信息

Department of Health Sciences, Global Health Unit, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.

Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.

出版信息

BMC Public Health. 2025 Jul 29;25(1):2570. doi: 10.1186/s12889-025-23791-0.

DOI:10.1186/s12889-025-23791-0

PMID:40731006

Abstract

BACKGROUND

The high-risk human papillomavirus (hrHPV)-based screening recommended by the World Health Organization is expected to lead to worldwide reduction of the cervical cancer burden, but the countries burdened most by cervical cancer also struggle with the costs of transitioning to this approach. Country-specific evaluations are needed to inform policymakers on implementation of hrHPV-based screening for their setting. Following initial implementation in Uganda, Bangladesh and Slovakia focused on underscreened women in the PRESCRIP-TEC project, we investigated the potential cost-effectiveness and affordability of hrHPV-based screening strategies.

METHODS

Country-specific model-based cost-effectiveness and budget impact analyses were conducted for the three countries, comparing the PRESCRIP-TEC strategy with the existing screening strategy in each setting. Data from initial project implementation informed the relevant model parameters.

RESULTS

The PRESCRIP-TEC strategy resulted in disability-adjusted life year (DALY) gains in all three countries. The cervical cancer incidence rate was reduced by a third for Uganda, 15% for Bangladesh and 11% for Slovakia. The incremental cost-effectiveness ratios were UGX 0.56 million per DALY for Uganda (I$ 475), BDT 76 thousand per DALY for Bangladesh (I$ 1698) and EUR 1782 (I$ 3637) per DALY for Slovakia. Substantial additional funding will be required to enable implementation, particularly in relation to the initial start-up costs.

CONCLUSIONS

The provided estimates can serve to inform policymakers and researchers in the context of implementing hrHPV-based screening in diverse settings.

摘要

背景

世界卫生组织推荐的基于高危型人乳头瘤病毒（hrHPV）的筛查有望在全球范围内减轻宫颈癌负担，但宫颈癌负担最重的国家在向这种筛查方法过渡的成本方面也面临困难。需要进行针对具体国家的评估，以便为政策制定者提供在其所在地区实施基于hrHPV筛查的信息。在乌干达、孟加拉国和斯洛伐克最初实施PRESCRIP-TEC项目，重点关注筛查不足的女性之后，我们调查了基于hrHPV筛查策略的潜在成本效益和可承受性。

方法

针对这三个国家进行了基于模型的特定国家成本效益和预算影响分析，将PRESCRIP-TEC策略与每个地区现有的筛查策略进行比较。来自项目初步实施的数据为相关模型参数提供了信息。

结果

PRESCRIP-TEC策略在所有三个国家都带来了伤残调整生命年（DALY）的增加。乌干达的宫颈癌发病率降低了三分之一，孟加拉国降低了15%，斯洛伐克降低了11%。乌干达的增量成本效益比为每DALY 56万乌干达先令（475美元），孟加拉国为每DALY 7.6万孟加拉塔卡（1698美元），斯洛伐克为每DALY 1782欧元（3637美元）。需要大量额外资金来推动实施，特别是在初始启动成本方面。