Economic evaluation of fifteen cervical cancer screening strategies in rural China
10.3760/cma.j.issn.0529-567x.2019.12.008
- VernacularTitle: 中国农村15种子宫颈癌筛查方案的卫生经济学评价
- Author:
Yuying WANG
1
;
Zhaojing WANG
2
;
Yu ZHANG
1
;
Xiaohong GAO
1
;
Chunxia YANG
3
;
Fanghui ZHAO
4
;
Youlin QIAO
4
;
Li MA
1
;
Jinghe LANG
5
Author Information
1. Department of Epidemiology, School of Public Health, Dalian Medical University, Dalian 116044, China
2. Department of Medical Records, Dalian Seventh People’s Hospital, Dalian 116033, China
3. Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu 610041, China
4. Department of Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
5. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
- Publication Type:Clinical Trail
- Keywords:
Uterine cervical neoplasms;
Markov chains;
Early detection of cancer;
Costs and cost analysis
- From:
Chinese Journal of Obstetrics and Gynecology
2019;54(12):840-847
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the feasible cervical cancer screening strategies in rural China.
Methods:The study was based on the health industry scientific research project of National Health Commission in 2015, cervical cancer screening technology and demonstration research suitable for rural areas in China, we collected health economics and epidemiological parameters and established the unscreening model and screening model with Treeage Pro 2011 software. Combining with the data acquired from site investigation, including population screening, treatment-related clinical materials and cost data, we simulated the occurrence and the development of cervical cancer of rural women in China under different screening and intervention programs and predicted the screening effects [cumulative incidence, cumulative risk of disease, life years and quality adjusted life years (QALY) , gains] and costs after 20 years, and using health economic evaluation analysis (cost-effectiveness analysis, cost-utility analysis, cost-benefit analysis). Screening programs included five screening strategies [visual inspection with acetic acid/lugol's iodine (VIA/VILI), careHPV, ThinPrep cytology test (TCT), careHPV+TCT, careHPV+VIA/VILI] and three screening intervals (1-year, 3-year, 5-year), a total of fifteen screening programs.
Results:Compared with no screening, fifteen screening programs reduced the cumulative incidence by 22.65%-51.76%. Compared with TCT or VIA/VILI, for the same screening interval, the reduced cumulative incidence, the amounts of life-year saved and QALY and benefits gained of careHPV were the highest. The cost-effectiveness ratios of these screening programs ranged (0.44-3.24)×104 Yuan per life-year saved, cost-utility ratios ranged (0.15- 1.01)×104 Yuan per QALY, benefit-cost ratios ranged 7.73-59.10. The results of incremental costeffectiveness ratios showed that VIA/VILI every five years, VIA/VILI every three years, careHPV every five years, careHPV every three years and careHPV every year were dominant programs.
Conclusions:VIA/VILI screening is cost-effective, careHPV is slightly more expensive but more effective. In rural China, careHPV screening every five years could be recommended. This study provides a basis for the determination of cervical cancer screening methods feasible for rural areas in China.
