Cost-effectiveness of an HPV self-collection campaign in Uganda: comparing models for delivery of cervical cancer screening in a low-income setting
Cost-effectiveness of an HPV self-collection campaign in Uganda: comparing models for delivery of cervical cancer screening in a low-income setting
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DOI：
10.1093/heapol/czw182
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发表时间：
2017-09-01
影响因子：
3.2
通讯作者：
Kim, Jane J.
中科院分区：
文献类型：
--
作者：
Campos, Nicole G.;Tsu, Vivien;Kim, Jane J.
随着可以由医疗保健提供者或妇女自己进行的低成本HPV DNA检测的可用性，方案规划者需要关于在不同医疗保健提供模式下在低资源环境中实施宫颈癌筛查方案的成本和成本效益的信息。使用START-UP示范项目的数据和微成本方法，我们估计了乌干达一生一次的HPV自我采集活动相对于基于诊所的HPV标本采集的健康和经济影响。我们使用基于个人的HPV和宫颈癌自然史的Monte Carlo模拟模型来估计与一生中一次HPV DNA检测筛查相关的终生健康和经济结果（基于诊所的提供者收集与自我收集活动）。测试性能和成本数据是使用微成本计算方法从启动示范项目中获得的。模型结果包括宫颈癌的终生风险、终生总成本（以2011年国际美元计算）和预期寿命。使用增量成本效益比（ICER）表示成本效益比。当这两项战略都达到75%的人口覆盖率时，ICER低于乌干达的人均国内生产总值（自我收集：每年挽救的生命80美元;提供者收集：每年挽救的生命120美元）。当自我收集运动达到15- 20%的覆盖率增益时，它比提供者收集更有效，并且具有较低的ICER，除非两种策略的覆盖率为50%或更低。这一分析的主要局限性是，自我收集费用是基于一个假设的运动，但基于乌干达的单位费用。一生一次的HPV自我采集筛查可能非常具有成本效益，如果覆盖率高，可将宫颈癌风险降低20%以上。将需要示范项目来确认我们的后勤、成本和合规假设的有效性。
With the availability of a low-cost HPV DNA test that can be administered by either a healthcare provider or a woman herself, programme planners require information on the costs and cost-effectiveness of implementing cervical cancer screening programmes in low-resource settings under different models of healthcare delivery. Using data from the START-UP demonstration project and a micro-costing approach, we estimated the health and economic impact of once-in-a-lifetime HPV self-collection campaign relative to clinic-based provider-collection of HPV specimens in Uganda. We used an individual-based Monte Carlo simulation model of the natural history of HPV and cervical cancer to estimate lifetime health and economic outcomes associated with screening with HPV DNA testing once in a lifetime (clinic-based provider-collection vs a self-collection campaign). Test performance and cost data were obtained from the START-UP demonstration project using a micro-costing approach. Model outcomes included lifetime risk of cervical cancer, total lifetime costs (in 2011 international dollars [I$]), and life expectancy. Cost-effectiveness ratios were expressed using incremental cost-effectiveness ratios (ICERs). When both strategies achieved 75% population coverage, ICERs were below Uganda's per capita GDP (self-collection: I$ 80 per year of life saved [YLS]; provider-collection: I$ 120 per YLS). When the self-collection campaign achieved coverage gains of 15-20%, it was more effective than provider-collection, and had a lower ICER unless coverage with both strategies was 50% or less. Findings were sensitive to cryotherapy compliance among screen-positive women and relative HPV test performance. The primary limitation of this analysis is that self-collection costs are based on a hypothetical campaign but are based on unit costs from Uganda. Once-in-a-lifetime screening with HPV self-collection may be very cost-effective and reduce cervical cancer risk by >20% if coverage is high. Demonstration projects will be needed to confirm the validity of our logistical, costing and compliance assumptions.