The costs, clinical benefits, and cost-effectiveness of screening for cervical cancer in HIV-infected women
The costs, clinical benefits, and cost-effectiveness of screening for cervical cancer in HIV-infected women
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DOI：
10.7326/0003-4819-130-2-199901190-00003
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发表时间：
1999-01-19
影响因子：
39.2
通讯作者：
Freedberg, KA
中科院分区：
文献类型：
--
作者：
Goldie, SJ;Weinstein, MC;Freedberg, KA
背景：感染 HIV 的女性比未感染 HIV 的女性患宫颈鳞状上皮内病变的风险更高，并且这些女性宫颈癌筛查的最佳方案尚不确定。目的：评估 HIV 感染女性宫颈肿瘤和癌症的各种筛查策略的净健康后果、成本和成本效益。设计：使用状态转移马尔可夫模型从社会角度进行成本效益分析。宫颈肿瘤发生率、进展和消退的数值；筛查和治疗的功效； HIV疾病的进展；艾滋病毒感染和癌症造成的死亡率；生活质量；背景：美国模拟临床实践。患者：代表美国人口的 HIV 感染女性。干预：六种主要筛查策略——不筛查、每年一次巴氏涂片、间隔 6 个月获得两次阴性涂片后每年一次巴氏涂片（美国疾病控制与预防中心推荐）、半年一次巴氏涂片、每年一次阴道镜检查和测量：质量调整生命年 (QALY)、终生成本和增量成本效益。结果：年度巴氏涂片筛查使质量调整预期寿命延长 2.1 个月，每节省 QALY 增量成本为 12 800 美元。相隔 6 个月获得两次阴性涂片后，每年进行巴氏涂片筛查，可额外获得 0.04 个 QALY，每个节省的 QALY 成本为 14 800 美元。每半年进行一次巴氏涂片筛查，可再提供 0.17 个 QALY，每个 QALY 节省的费用为 27 600 美元。与半年一次的巴氏涂片筛查相比，每年一次的阴道镜检查费用更高，但没有提供额外的好处，并且半年一次的阴道镜检查每节省 QALY 超过 375 000 美元。结果对肿瘤进展为浸润性癌症的速度最为敏感。 结论：对于感染 HIV 的女性，在间隔 6 个月获得两次阴性涂片后每年进行巴氏涂片筛查宫颈癌，可提供质量调整后的预期寿命益处，且成本与其他临床预防干预措施相当。
Background: Women with HIV infection have a higher risk for cervical squamous intraepithelial lesions than do women without HIV infection, and the optimal regimen for cervical cancer screening in these women is uncertain.Objective: To assess the net health consequences, costs, and cost-effectiveness of Various screening strategies for cervical neoplasia and cancer in HIV-infected women.Design: A cost-effectiveness analysis from a societal perspective done by using a state-transition Markov model. Values for incidence, progression, and regression of cervical neoplasia; efficacy of screening and treatment; progression of HIV disease; mortality from HIV infection and cancer; quality of life; and costs were obtained from the literature.Setting: Simulated clinical practice in the United States.Patients: HIV-infected women representative of the U.S. population.Intervention: Six main screening strategies-no screening, annual Papanicolaou smears, annual Papanicolaou smears after two negative smears obtained 6 months apart (recommended by the Centers for Disease Control and Prevention), semiannual Papanicolaou smears, annual colposcopy, and semiannual colposcopy-were considered.Measurements: Quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness.Results: Annual Papanicolaou smear screening resulted in a 2.1-month gain in quality-adjusted life expectancy for an incremental cost of $12 800 per QALY saved. Annual Papanicolaou smear screening after two negative smears obtained 6 months apart provided an additional 0.04 QALYs at a cost of $14 800 per QALY saved. Semiannual Papanicolaou smear screening provided a further 0.17 QALYs at a cost of $27 600 per QALY saved. Annual colposcopy cost more but provided no additional benefit compared with that given by semiannual Papanicolaou smear screening, and semiannual colposcopy exceeded $375 000 per QALY saved. Results were most sensitive to the rate of progression of neoplasia to invasive cancer.Conclusions: in HIV-infected women, cervical cancer screening with annual Papanicolaou smears after two negative smears obtained 6 months apart offers quality-adjusted life expectancy benefits at a cost comparable to that of other clinical preventive interventions.