The health and economic impact of scaling cervical cancer prevention in 50 low-and lower-middle-income countries
The health and economic impact of scaling cervical cancer prevention in 50 low-and lower-middle-income countries
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DOI：
10.1002/ijgo.12184
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发表时间：
2017-07-01
影响因子：
3.8
通讯作者：
Resch, Stephen
中科院分区：
文献类型：
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作者：
Campos, Nicole G.;Sharma, Monisha;Resch, Stephen
目标：评估扩大人乳头瘤病毒 (HPV) 疫苗接种（年轻女孩）和宫颈癌筛查（筛查年龄的女性）覆盖范围对可能需要捐助者援助的国家妇女的健康影响、财务成本和成本效益。方法：我们使用基于模型的方法来综合 50 个低收入和中低收入国家的人口、人口和流行病学数据。使用模型来预测以下方面的成本（美元）、终生健康影响（宫颈癌病例、避免的死亡）和成本效益（每个残疾调整生命年 [DALY] 避免的成本效益）：(1) 10 岁女孩接种两剂 HPV-16/18 疫苗； (2) 对 35 岁的女性进行一生一次的筛查，必要时进行治疗，采用 HPV DNA 检测或醋酸目视检查 (VIA)； (3) 为期 10 年的宫颈癌治疗。结果：我们估计 HPV 疫苗接种和筛查都非常具有成本效益，一项综合计划可以在干预队列的一生中避免 520 万例病例、370 万人死亡和 2200 万伤残调整生命年 (DALY)，10 年计划的总成本为 32 亿美元。结论：投资于年轻女孩的 HPV 疫苗接种和宫颈癌 低收入和中低收入国家的筛查和治疗方案可以避免沉重的疾病负担，同时为公共卫生资金提供良好的价值。
Objective: To estimate the health impact, financial costs, and cost-effectiveness of scaling-up coverage of human papillomavirus (HPV) vaccination (young girls) and cervical cancer screening (women of screening age) for women in countries that will likely need donor assistance.Methods: We used a model-based approach to synthesize population, demographic, and epidemiological data from 50 low-and lower-middle-income countries. Models were used to project the costs (US $), lifetime health impact (cervical cancer cases, deaths averted), and cost-effectiveness (US $ per disability adjusted life year [ DALY] averted) of: (1) two-dose HPV-16/18 vaccination of girls aged 10 years; (2) once-in-a-lifetime screening, with treatment when needed, of women aged 35 years with either HPV DNA testing or visual inspection with acetic acid (VIA); and (3) cervical cancer treatment over a 10-year roll-out.Results: We estimated that both HPV vaccination and screening would be very cost-effective, and a comprehensive program could avert 5.2 million cases, 3.7 million deaths, and 22.0 million DALYs over the lifetimes of the intervention cohorts for a total 10-year program cost of US $ 3.2 billion.Conclusion: Investment in HPV vaccination of young girls and cervical cancer screen-and-treat programs in low-and lower-middle-income countries could avert a substantial burden of disease while providing good value for public health dollars.