Resources Required for Cervical Cancer Prevention in Low- and Middle-Income Countries.
Resources Required for Cervical Cancer Prevention in Low- and Middle-Income Countries.
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DOI：
10.1371/journal.pone.0164000
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Resch SC
中科院分区：
文献类型：
--
作者：
Campos NG;Sharma M;Clark A;Kim JJ;Resch SC
宫颈癌是妇女癌症死亡的第四大原因，85%的病例和死亡发生在发展中国家。虽然有组织的筛查方案通过检测和治疗癌前病变降低了高收入国家的宫颈癌发病率，但由于缺乏基础设施和预算有限，在低资源环境中实施有组织的筛查并不有效。我们的目标是估计低收入和中等收入国家综合性初级和二级宫颈癌预防的成本。我们进行了一项建模分析，以估计1）10岁女孩的2剂人乳头瘤病毒（HPV）疫苗接种的费用; 2）30至49岁女性的宫颈癌筛查（醋酸目视检查（VIA），HPV检测或细胞学检查）和预防性治疗的费用在102个低收入和中等收入国家从2015年到2024年。我们使用基于Excel的成本计算和服务利用模型，根据HPV的患病率、癌前病变的患病率和筛查测试性能来估计财务成本（2013年美元）。在流行病学数据不可用的地方，我们使用基于个体的宫颈癌发生微观模拟模型（校准到20个设置）和多变量回归从数据设置中推断。在所有考虑的情况下，HPV疫苗接种总成本从86亿美元到242亿美元不等（立即，5年或10年推广;按国家收入水平计算，每剂价格为4.55 - 70美元）。筛查和预防性治疗的总成本从51亿美元（10年推广，35岁时筛查一次）到423亿美元（立即推广，高强度筛查）不等。这种分析的局限性包括：假设国家收入水平的标准化方案没有考虑到一个国家内可能存在的多种筛查模式或管理策略，以及将成本和流行病学数据外推到数据有限的环境中。对10岁女孩进行两剂HPV疫苗接种和对30至49岁妇女进行筛查的综合宫颈癌预防的估计成本从137亿美元到665亿美元不等，具体取决于推广速度，每剂疫苗的价格以及筛查测试和频率。研究结果表明，疫苗价格对没有资格获得疫苗联盟援助的中等收入国家产生了重大影响。以HPV为基础的筛查取代常规细胞学检查可能会降低总成本。需要关于战略的健康影响和相对成本效益的数据，以确定公共卫生资金的最佳价值。
Cervical cancer is the fourth leading cause of cancer death in women, with 85% of cases and deaths occurring in developing countries. While organized screening programs have reduced cervical cancer incidence in high-income countries through detection and treatment of precancerous lesions, the implementation of organized screening has not been effective in low-resource settings due to lack of infrastructure and limited budgets. Our objective was to estimate the cost of comprehensive primary and secondary cervical cancer prevention in low- and middle-income countries. We performed a modeling analysis to estimate 1) for girls aged 10 years, the cost of 2-dose human papillomavirus (HPV) vaccination; and 2) for women aged 30 to 49 years, the cost of cervical cancer screening (with visual inspection with acetic acid (VIA), HPV testing, or cytology) and preventive treatment in 102 low- and middle-income countries from 2015 to 2024. We used an Excel-based costing and service utilization model to estimate financial costs (2013 US$) based on prevalence of HPV, prevalence of precancerous lesions, and screening test performance. Where epidemiologic data were unavailable, we extrapolated from settings with data using an individual-based microsimulation model of cervical carcinogenesis (calibrated to 20 settings) and multivariate regression. Total HPV vaccination costs ranged from US$8.6 billion to US$24.2 billion for all scenarios considered (immediate, 5-year, or 10-year roll-out; price per dose US$4.55-US$70 by country income level). The total cost of screening and preventive treatment ranged from US$5.1 billion (10-year roll-out, screening once at age 35 years) to US$42.3 billion (immediate roll-out, high intensity screening). Limitations of this analysis include the assumption of standardized protocols by country income level that did not account for the potential presence of multiple screening modalities or management strategies within a country, and extrapolation of cost and epidemiologic data to settings where data were limited. The estimated cost of comprehensive cervical cancer prevention with 2-dose HPV vaccination of 10-year-old girls and screening of women aged 30 to 49 years ranges from US$13.7 billion to US$66.5 billion, depending on speed of roll-out, vaccine price per dose, and screening test and frequency. Findings demonstrate the substantial impact of vaccine price in middle-income countries that are not eligible for assistance from Gavi, the Vaccine Alliance. Replacing routine cytology with HPV-based screening may reduce total costs. Data on the health impact and relative cost-effectiveness of strategies are needed to determine the best value for public health dollars.
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影响因子：
11.1
作者：
Levin, Carol E.;Hoang Van Minh;LaMontagne, D. Scott
通讯作者：
LaMontagne, D. Scott
DOI：
10.1590/s1020-49892012001400006
发表时间：
2012-12-01
期刊：
Revista Panamericana de Salud Pública
影响因子：
--
作者：
Goldie, Sue J.;Levin, Carol;Mendoza Araujo, Maria Ana
通讯作者：
Mendoza Araujo, Maria Ana
HPV 16和18印度疫苗接种和宫颈癌筛查的健康和经济影响。
影响因子：
8.8
作者：
Diaz, M.;Kim, J. J.;Albero, G.;de Sanjose, S.;Clifford, G.;Bosch, F. X.;Goldie, S. J.
通讯作者：
Goldie, S. J.
57个国家 /地区的宫颈癌筛查覆盖范围：平均水平低和较大的不平等。
影响因子：
15.8
作者：
Gakidou, Emmanuela;Nordhagen, Stella;Obermeyer, Ziad
通讯作者：
Obermeyer, Ziad
影响因子：
6.4
作者：
Gage, Julia C.;Ajenifuja, Kayode O.;Schiffman, Mark
通讯作者：
Schiffman, Mark