摘要
目的对宫颈癌多种筛查方案终生筛查一次的效果进行卫生经济学评价，并探讨最具有成本效果的筛查起始年龄。方法在农村地区选择醋酸／碘染色肉眼观察检查（VIA／VIM）、传统巴氏细胞学检测（Pap Smear）和简易人乳头瘤病毒（HPV）DNA检测（careHPV）3种筛查方法，城市地区选择PAP Smear、液基细胞学检测（LBC）、coreHPV、HPVDNA检测（HC2）和LBC联合HC2检测（LBC＋HC2）5种筛查方法。运用Markov模型，预测在不同筛查起始年龄终生筛查一次的远期流行病学和卫生经济学效果。结果在农村和城市地区，各筛查方案队列人群20年后挽救的累积生命年分别为277．97年／10万人至2727．53年／10万人和134．02年／10万人至1446．84年／10万人；与对照组相比，各筛查方案每挽救一个生命年的成本分别在1520．99～2453．74元和3847．35～44570．35元之间；增量成本效果分析显示，农村地区的优势方案依次为careHPV40岁和careHPV30岁起始筛查方案，城市地区的优势方案依次为careHPV40岁、careHPV30岁、HC230岁和LBC＋HC230岁起始筛查方案。结论如妇女终生接受一次筛查，农村和城市地区所有评价方案均具有成本效果，careHPV40岁起始筛查是中国农村和城市地区最具有成本效果的筛查方案。
Objective To estimate the cost-effectiveness of once-in-a-lifetime cervical cancer screening program and to predict the optimal modality for its operation on women living in rural and urban areas of China, based on Markov modeling and simulation. Methods Three modalities including visual inspection with acetic acid plus Lugol＇ s iodine （VIANILI）, conventional Pap Smear （Pap Smear） , and simple HPV DNA testing （careHPV） were hypothesized for the rural cohort, whereas other five modalities including Pap Smear, liquid-based cytology （LBC）, simple HPV DNA testing （careHPV）, Hybrid Capture 2 HPV DNA testing （HC2）, and LBC plus HC2 （LBC ＋ HC2） were tested for the urban cohort. A Markov model was constructed based on the factors as natural history, screening, diagnosis and treatment on cervical cancer using data related to the epidemics and the costs from rural and urban areas of the country. Long-term effectiveness and cost-effectiveness were predicted through simulation of the model. Results Compared to the non-screening scenario, the amount of life years saved were 277.97-2727.53 and 134.02-1446.84 years per 100 000 women, respectively, for different cohorts in rural and urban areas. The cost-effectiveness ratios were 1520.99-2453.74 and 3847.35-44 570.35 RMB per life year saved, respectively, for different cohorts in rural and urban areas. The incremental cost-effective ratio for careHPV starting from 40 years old （careHPV@40） and careHPV from 30 years old （careHPV@30） dominated other strategies for the rural cohort, while careHPV@40, careHPV@30, HC2 from 30 years old（HC2@30）, and LBC ＋HC2 from 30 years old （LBC＋HC2@30） were dominant for the urban cohort. Conclusion All eight once-in-a-lifetime cervical cancer screening modalities were cost-effective based on our model. In particular, careHPV screening starting from 40 years old seemed to be the most cost-effective one for women living in both rural and urban areas.
出处
《中华流行病学杂志》
CAS
CSCD
北大核心
2013年第4期399-403,共5页
Chinese Journal of Epidemiology
基金
国家“十一五”科技支撑计划（2006BAI02A15）
