Inefficiencies of over-screening and under-screening for cervical cancer prevention in the US
Inefficiencies of over-screening and under-screening for cervical cancer prevention in the US
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DOI：
10.1016/j.ypmed.2018.03.011
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发表时间：
2018-06-01
影响因子：
5.1
通讯作者：
Kim, Jane J.
中科院分区：
文献类型：
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作者：
Castle, Philip E.;Wheeler, Cosette M.;Kim, Jane J.
关于不遵守建议的宫颈癌筛查的成本效益低或改善不遵守的潜在价值的信息有限。我们使用一个疾病模拟模型，结合来自新墨西哥州的真实筛查实践数据，估计了坚持每三年进行一次推荐的细胞学筛查的增量价值。通过计算当前实践（假设混合依从人群）和不完全或完全依从筛查阳性女性随访的一致不依从人群的情况下的增量净货币获益（INMB），估计可用于提高依从性的金额。每三年让未筛查的妇女接受一次细胞学筛查，比在筛查不足的妇女中增加筛查或在筛查过度的妇女中减少筛查更有价值。例如，INMB是3998美元，用于筛查以前未筛查的妇女，而取消年度筛查的INMB是136美元，愿意支付的门槛是每获得10万美元的质量调整生命年。接触未经筛查的妇女的战略是潜在的高价值投资。
There is limited information on the cost-inefficiencies of non-adherence to recommended cervical cancer screening or the potential value for improving non-adherence. We estimated the incremental value of adhering to recommended screening every three years with cytology, using a disease simulation model that integrated real-world screening practice data from New Mexico. The amount that can be spent to improve adherence was estimated by calculating the incremental net monetary benefit (INMB) under scenarios of Current Practice (assuming a population of mixed adherence) and Uniformly Non-Adherent populations with imperfect or perfect adherence to follow-up of screen-positive women. Getting unscreened women screened every three years by cytology was a better value than increasing screening in the under-screened or reducing screening in the over-screened. For example, INMBs were $3998 for screening previously unscreened women versus $136 for eliminating annual screening at a willingness-to-pay threshold of $100,000 per quality-adjusted life-year gained. Strategies to reach unscreened women are potentially high-value investments.