Cost-effectiveness analysis for Pap smear screening and human papillomavirus DNA testing and vaccination
Cost-effectiveness analysis for Pap smear screening and human papillomavirus DNA testing and vaccination
复制标题
DOI：
10.1111/j.1365-2753.2010.01453.x
复制
发表时间：
2011-12-01
影响因子：
2.4
通讯作者：
Chen, Hsiu-Hsi
中科院分区：
文献类型：
--
作者：
Chen, Meng-Kan;Hung, Hui-Fang;Chen, Hsiu-Hsi
由于以细胞学为基础的子宫颈癌普查计划在降低死亡率方面的成效已达高峰期，当局已考虑采取各种预防策略，包括加强子宫颈抹片检查和补充使用人类乳头瘤病毒DNA测试或人类乳头瘤病毒疫苗接种。因此，这些不同的预防策略的成本和有效性是卫生政策制定者非常关注的问题。目的我们打算评估是否HPV DNA检测或HPV疫苗接种与巴氏涂片筛查计划相结合，或单独的年度巴氏涂片筛查更有效和成本更低。在预防子宫颈癌方面比现有的三年一次的巴氏涂片筛查计划更有效。方法构建马尔可夫决策模型，比较不同预防策略（包括每年一次的子宫颈抹片检查、人类乳头状瘤病毒DNA测试或人类乳头状瘤病毒疫苗接种和子宫颈抹片检查计划）与三年一次的子宫颈抹片检查（对照）的总成本和效果。采用概率成本-效果（C-E）分析方法，绘制了一系列散布在C-E平面上的模拟增量C-E比，并得到了不同策略比较的可接受性曲线。结果与3年一次的巴氏涂片筛查相比，除3年一次的巴氏涂片筛查占主导地位的每5年一次的HPV DNA检测外，大多数预防策略的成本较高，但可获得额外的生命年（C-E平面象限I）。最具成本效益的策略是每年进行巴氏涂片检查（递增C-E比率= 31 698美元），其次是HPV DNA检测和每3年一次的巴氏涂片检查（36 627美元），以及疫苗接种计划和每3年一次的巴氏涂片筛查（44 688美元），根据可接受性曲线得出的相应成本效益概率为65.52%，52.08%和35.84%的人愿意支付40000美元的门槛。疫苗接种结合三年一次的巴氏涂片检查将是具有成本效益的每年巴氏涂片提供的疫苗接种的成本降低到250美元，每一个完整的course of injection.Conclusions在各种预防策略每年巴氏涂片筛查计划仍然是最具成本效益和额外的HPV DNA检测是一个具有成本效益的选择下，合理的阈值愿意支付。如果疫苗成本能够在大的经济规模内大幅降低，则疫苗接种计划与三年一次的筛查相结合将具有成本效益。
Introduction As the effectiveness of cytology-based screening programme for cervical cancer in mortality reduction has reached a plateau, various preventive strategies have been considered, including intensive Pap smear screening and the supplemental use of human papillomavirus (HPV) DNA test or HPV vaccination. Cost and effectiveness of these various preventive strategies are therefore of great concern for health policy makers.Objective We intended to assess whether the combination of HPV DNA testing or HPV vaccination with Pap smear screening programme or the sole annual Pap smear screening is more effective and cost-effective in prevention of cervical cancer than the existing triennial Pap smear screening programme.Methods A Markov decision model was constructed to compare total costs and effectiveness between different preventive strategies (including annual Pap smear, HPV DNA testing or HPV vaccination together with Pap smear screening programme) as opposed to the triennial Pap smear screening alone (the comparator). Probabilistic cost-effectiveness (C-E) analysis was adopted to plot a series of simulated incremental C-E ratios scattered over C-E plane and also to yield the acceptability curve for different comparisons of strategies. The threshold of vaccine cost and the influence of attendance rate were also investigated.Results Compared with triennial Pap smear screening programme, most of preventive strategies cost more but gain additional life years (quadrant I of C-E plane) except HPV DNA testing with Pap smear every 5 years dominated by triennial Pap smear screening programme. The most cost-effective strategy was annual Pap smear (incremental C-E ratio = $31 698), followed by HPV DNA testing with Pap smear every 3 years ($36 627), and vaccination programme with triennial Pap smear screening ($44 688) with the corresponding cost-effective probabilities by the acceptability curve being 65.52%, 52.08% and 35.84% given the threshold of $40 000 of willingness to pay. Vaccination combined with triennial Pap smear would be as cost-effective as annual Pap smear provided the cost of vaccination was lowered to $250 per full course of injection.Conclusions Among various preventive strategies annual Pap smear screening programme is still the most cost-effective and additional HPV DNA testing is a cost-effective choice under a reasonable threshold of willingness to pay. Vaccination programme in combination with triennial screening would be cost-effective if vaccine cost can be greatly reduced in a large economic scale.