Cost-effectiveness of cervical-cancer screening in five developing countries
Cost-effectiveness of cervical-cancer screening in five developing countries
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DOI：
10.1056/nejmsa044278
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发表时间：
2005-11-17
影响因子：
158.5
通讯作者：
Wright, TC
中科院分区：
文献类型：
--
作者：
Goldie, SJ;Gaffikin, L;Wright, TC
背景：宫颈癌筛查策略，涉及使用传统的细胞学，需要多次访问已不切实际的发展中countries.Methods：我们使用基于计算机的模型来评估各种宫颈癌筛查策略的成本效益在印度，肯尼亚，秘鲁，南非和泰国。原始数据与文献数据相结合，以估计癌症的年龄特异性发病率和死亡率以及癌前病变筛查和治疗的有效性。我们评估了根据筛查测试、目标年龄和频率以及所需的诊所就诊次数而不同的策略的直接医疗、时间和项目相关成本。单次访视策略假设筛查和治疗可以在同一天提供。结果包括癌症的终生风险，挽救生命的年数，终生成本和成本效益比（每年挽救生命的成本）。结果：最具成本效益的策略是那些需要最少的访问，从而改善后续检测和治疗。妇女一生中在35岁时进行一次筛查，采用一次或两次筛查策略，包括用醋酸对宫颈进行目视检查或对宫颈细胞样本中的人乳头瘤病毒（HPV）进行DNA检测，可将癌症的终生风险降低约25%至36%，每年挽救生命的成本不到500美元。两次筛查的相对癌症风险降低了40%根据宏观经济学和卫生委员会的数据，每年挽救生命的成本低于每个国家的人均国内生产总值，这是一个非常具有成本效益的结果。宫颈癌筛查策略包括在一次或两次临床就诊中用醋酸对宫颈进行目视检查或HPV DNA检测，在资源匮乏的环境中，有效替代传统的三次访问细胞学筛查计划。
Background:Cervical-cancer screening strategies that involve the use of conventional cytology and require multiple visits have been impractical in developing countries.Methods:We used computer-based models to assess the cost-effectiveness of a variety of cervical-cancer screening strategies in India, Kenya, Peru, South Africa, and Thailand. Primary data were combined with data from the literature to estimate age-specific incidence and mortality rates for cancer and the effectiveness of screening for and treatment of precancerous lesions. We assessed the direct medical, time, and program-related costs of strategies that differed according to screening test, targeted age and frequency, and number of clinic visits required. Single-visit strategies involved the assumption that screening and treatment could be provided in the same day. Outcomes included the lifetime risk of cancer, years of life saved, lifetime costs, and cost-effectiveness ratios (cost per year of life saved).Results:The most cost-effective strategies were those that required the fewest visits, resulting in improved follow-up testing and treatment. Screening women once in their lifetime, at the age of 35 years, with a one-visit or two-visit screening strategy involving visual inspection of the cervix with acetic acid or DNA testing for human papillomavirus (HPV) in cervical cell samples, reduced the lifetime risk of cancer by approximately 25 to 36 percent, and cost less than $500 per year of life saved. Relative cancer risk declined by an additional 40 percent with two screenings (at 35 and 40 years of age), resulting in a cost per year of life saved that was less than each country's per capita gross domestic product - a very cost-effective result, according to the Commission on Macroeconomics and Health.Conclusions:Cervical-cancer screening strategies incorporating visual inspection of the cervix with acetic acid or DNA testing for HPV in one or two clinical visits are cost-effective alternatives to conventional three-visit cytology-based screening programs in resource-poor settings.