Inefficiencies and High-Value Improvements in U.S. Cervical Cancer Screening Practice: A Cost-Effectiveness Analysis.
Inefficiencies and High-Value Improvements in U.S. Cervical Cancer Screening Practice: A Cost-Effectiveness Analysis.
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DOI：
10.7326/m15-0420
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发表时间：
2015-10-20
影响因子：
39.2
通讯作者：
New Mexico HPV Pap Registry Steering Committee
中科院分区：
文献类型：
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作者：
Kim JJ;Campos NG;Sy S;Burger EA;Cuzick J;Castle PE;Hunt WC;Waxman A;Wheeler CM;New Mexico HPV Pap Registry Steering Committee
研究表明，美国的宫颈癌筛查效率低下。与推荐的指南相比，筛查过程中不遵守规定的成本和健康影响尚不确定。评估当前宫颈癌筛查实践的收益、成本和成本效益，并评估筛查改进的价值。基于模型的成本效益分析。新墨西哥州 HPV 巴氏涂片登记；医学文献。有资格接受常规筛查的女性群体。寿命。社会的。目前的宫颈癌筛查实践；提高对基于指南的筛查间隔、分诊测试、诊断转诊和癌前治疗转诊的依从性。终生宫颈癌风险、质量调整生命年 (QALY)、终生成本、增量成本效益比 (ICER)、增量净货币效益 (INMB) 的降低 目前的筛查实践与较低的健康效益相关，并且相对于基于指南的策略而言不具有成本效益。筛查过程的改进与更高的 QALY 和成本的小变化相关。完全符合 3 年筛查 间隔时间和阴道镜检查/活检转诊与最高 INMB 相关（每获得 QALY 的支付意愿门槛为 100,000 美元，分别为 759 美元和 741 美元）； INMB 合计增加至 1,645 美元。目前的筛选实践在 100% 的模拟中效率较低。根据 INMB 的筛选改进的排名顺序在一系列筛选输入和范围内是稳定的 支付意愿门槛。没有考虑 HPV 疫苗接种的影响。提高对指南的依从性带来的额外健康益处，特别是细胞学筛查和诊断随访的每三年间隔，可能证明在干预措施上进行额外投资以改善美国宫颈癌筛查实践是合理的。美国国家癌症研究所。
Studies suggest that cervical cancer screening practice in the United States is inefficient. The cost and health implications of non-compliance in the screening process compared to recommended guidelines are uncertain. To estimate the benefits, costs, and cost-effectiveness of current cervical cancer screening practice and assess the value of screening improvements. Model-based cost-effectiveness analysis. New Mexico HPV Pap Registry; medical literature. Cohort of women eligible for routine screening. Lifetime. Societal. Current cervical cancer screening practice; improved compliance to guidelines-based screening interval, triage testing, diagnostic referrals, and precancer treatment referrals. Reductions in lifetime cervical cancer risk, quality-adjusted life-years (QALYs), lifetime costs, incremental cost-effectiveness ratios (ICERs), incremental net monetary benefits (INMBs Current screening practice was associated with lower health benefit and was not cost-effective relative to guidelines-based strategies. Improvements in the screening process were associated with higher QALYs and small changes in costs. Perfect c4mpliance to a 3-yearly screening interval and to colposcopy/biopsy referrals were associated with the highest INMBs ($759 and $741, respectively, at a willingness-to-pay threshold of $100,000 per QALY gained); together, the INMB increased to $1,645. Current screening practice was inefficient in 100% of simulations. The rank ordering of screening improvements according to INMBs was stable over a range of screening inputs and willingness-to-pay thresholds. The impact of HPV vaccination was not considered. The added health benefit of improving compliance to guidelines, especially the 3-yearly interval for cytology screening and diagnostic follow-up, may justify additional investments in interventions to improve U.S. cervical cancer screening practice. U.S. National Cancer Institute.