摘要
目的通过评价多种子宫颈癌筛查方案的生物学和卫生经济学效果，探索适合在我国不同卫生和经济水平地区推广的子宫颈癌筛查方案。方法使用Markov模型，分别测算农村和城市地区不筛查组和各种筛查方案组的远期效果、效用、效益和费用，进行成本效果、成本效用和成本效益分析。农村地区评价的筛查方法是醋酸染色和碘染色肉眼观察、传统巴氏细胞学和简易人乳头瘤病毒（HPV）DNA检测（care HPV）；城市地区评价的筛查方法是传统巴氏细胞学、careHPV、液基细胞学（LBC）、HPVDNA检测（HC2）和LBC联合HPVDNA检测（LBC＋HC2）；对以上筛查方案每1年、3年和5年筛查1次的生物学和卫生经济学效果进行评价。结果各种筛查方案均能有效降低子宫颈癌死亡率和增加生命年，筛查频次越高，效果越好。然而，无论城市还是农村，与careHPV检测每5年筛查1次相比，其他筛查方案每避免1例死亡、每挽救1个生命年和每挽救1个质量调整生命年（QALY）的成本分别是其的1．28－13．86倍、1．31—14．14倍和1．27－12．80倍，每投入1个单位成本所获得的效益是其的9．9％－90．2％。结论careHPV每5年筛查1次是成本效果和效益最优的方案，可作为我国城乡地区大范围推广的子宫颈癌筛查方案的最佳选择。经济较好地区也可考虑采用CareHPV检测每3年筛查1次。
Objective To explore the appropriate strategies which are suitable for the areas with diverse health and economic resource settings in China by estimating the life outcomes and cost-effectiveness of several cervical cancer screening strategies. Methods Markov model was used to calculate the long-term effectiveness, utility, benefit and cost among screened and unscreened cohorts in rural and urban areas, and then analyses of cost-effectiveness, cost-utility and cost-benefit were performed. The assessed screening strategies were acetic acid of visual inspection combined with Lugol＇ s iodine staining （VIA/VILI）, conventional Pap smear and simple HPV DNA testing （careHPV） in rural areas, and conventional Pap smear, simple HPV DNA testing （ careHPV）, HPV DNA testing （HC2） and liquld-based cytology （LBC） alone or combined with HPV DNA testing （LBC ＋ I-IC2） in urban areas. We estimated the life outcomes and cost-effectiveness of the above screening strategies at one-year, 3-year and 5-year intervals. Results All of the screening strategies were effective to decrease cervical cancer mortality and to increase life years, with a trend of shorter screening interval having better effectiveness. However, no matter in urban or rural areas, compared with careHPV testing at 5-year interval, the costs of other screening strategies were 1.28-13.86 folds, 1.31-14.14 folds, and 1.27-12.80 folds higher to avoid one death, to save a year of life, and a QALY, and the benefit per cost of other screening strategies was 9.9%-90.2%. Conclusions careHPV testing at 5-year interval has the best cost-effectiveness performance and the highest benefit-cost ratio with the moderate life outcomes. It is the optimal cervical cancer screening strategy to be generalized in our country. careHPV testing at 3 years interval can be considered in more developed areas to achieve better effectiveness.
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2012年第8期632-636,共5页
Chinese Journal of Oncology
基金
十一五国家科技支撑计划课题（2006BA102A15）
关键词
宫颈肿瘤
普查
成本及成本分析
费用效益分析
Uterine cervical neoplasms
Mass screening
Costs and cost analysis
cost- benefit analysis
