中华肿瘤杂志
中華腫瘤雜誌
중화종류잡지
CHINESE JOURNAL OF ONCOLOGY
2012年
8期
632-636
,共5页
赵方辉%陈俊峰%高晓虹%高丽敏%刘启贵%刘植华%徐赫%马俊飞%马莉%徐小玲%胡尚英%宁岩%石菊芳%乔友林
趙方輝%陳俊峰%高曉虹%高麗敏%劉啟貴%劉植華%徐赫%馬俊飛%馬莉%徐小玲%鬍尚英%寧巖%石菊芳%喬友林
조방휘%진준봉%고효홍%고려민%류계귀%류식화%서혁%마준비%마리%서소령%호상영%저암%석국방%교우림
宫颈肿瘤%普查%成本及成本分析%费用效益分析
宮頸腫瘤%普查%成本及成本分析%費用效益分析
궁경종류%보사%성본급성본분석%비용효익분석
Uterine cervical neoplasms%Mass screening%Costs and cost analysis%cost-benefit analysis
目的 通过评价多种子宫颈癌筛查方案的生物学和卫生经济学效果,探索适合在我国不同卫生和经济水平地区推广的子宫颈癌筛查方案.方法 使用Markov模型,分别测算农村和城市地区不筛查组和各种筛查方案组的远期效果、效用、效益和费用,进行成本效果、成本效用和成本效益分析.农村地区评价的筛查方法是醋酸染色和碘染色肉眼观察、传统巴氏细胞学和简易人乳头瘤病毒(HPV) DNA检测(careH PV)；城市地区评价的筛查方法是传统巴氏细胞学、careHPV、液基细胞学(LBC)、HPV DNA检测(HC2)和LBC联合HPV DNA检测(LBC+ HC2)；对以上筛查方案每1年、3年和5年筛查1次的生物学和卫生经济学效果进行评价.结果 各种筛查方案均能有效降低子宫颈癌死亡率和增加生命年,筛查频次越高,效果越好.然而,无论城市还是农村,与careHPV检测每5年筛查1次相比,其他筛查方案每避免1例死亡、每挽救1个生命年和每挽救1个质量调整生命年(QALY)的成本分别是其的1.28～ 13.86倍、1.31～14.14倍和1.27～12.80倍,每投入1个单位成本所获得的效益是其的9.9％～90.2％.结论 careHPV每5年筛查1次是成本效果和效益最优的方案,可作为我国城乡地区大范围推广的子宫颈癌筛查方案的最佳选择.经济较好地区也可考虑采用careHPV检测每3年筛查1次.
目的 通過評價多種子宮頸癌篩查方案的生物學和衛生經濟學效果,探索適閤在我國不同衛生和經濟水平地區推廣的子宮頸癌篩查方案.方法 使用Markov模型,分彆測算農村和城市地區不篩查組和各種篩查方案組的遠期效果、效用、效益和費用,進行成本效果、成本效用和成本效益分析.農村地區評價的篩查方法是醋痠染色和碘染色肉眼觀察、傳統巴氏細胞學和簡易人乳頭瘤病毒(HPV) DNA檢測(careH PV)；城市地區評價的篩查方法是傳統巴氏細胞學、careHPV、液基細胞學(LBC)、HPV DNA檢測(HC2)和LBC聯閤HPV DNA檢測(LBC+ HC2)；對以上篩查方案每1年、3年和5年篩查1次的生物學和衛生經濟學效果進行評價.結果 各種篩查方案均能有效降低子宮頸癌死亡率和增加生命年,篩查頻次越高,效果越好.然而,無論城市還是農村,與careHPV檢測每5年篩查1次相比,其他篩查方案每避免1例死亡、每輓救1箇生命年和每輓救1箇質量調整生命年(QALY)的成本分彆是其的1.28～ 13.86倍、1.31～14.14倍和1.27～12.80倍,每投入1箇單位成本所穫得的效益是其的9.9％～90.2％.結論 careHPV每5年篩查1次是成本效果和效益最優的方案,可作為我國城鄉地區大範圍推廣的子宮頸癌篩查方案的最佳選擇.經濟較好地區也可攷慮採用careHPV檢測每3年篩查1次.
목적 통과평개다충자궁경암사사방안적생물학화위생경제학효과,탐색괄합재아국불동위생화경제수평지구추엄적자궁경암사사방안.방법 사용Markov모형,분별측산농촌화성시지구불사사조화각충사사방안조적원기효과、효용、효익화비용,진행성본효과、성본효용화성본효익분석.농촌지구평개적사사방법시작산염색화전염색육안관찰、전통파씨세포학화간역인유두류병독(HPV) DNA검측(careH PV)；성시지구평개적사사방법시전통파씨세포학、careHPV、액기세포학(LBC)、HPV DNA검측(HC2)화LBC연합HPV DNA검측(LBC+ HC2)；대이상사사방안매1년、3년화5년사사1차적생물학화위생경제학효과진행평개.결과 각충사사방안균능유효강저자궁경암사망솔화증가생명년,사사빈차월고,효과월호.연이,무론성시환시농촌,여careHPV검측매5년사사1차상비,기타사사방안매피면1례사망、매만구1개생명년화매만구1개질량조정생명년(QALY)적성본분별시기적1.28～ 13.86배、1.31～14.14배화1.27～12.80배,매투입1개단위성본소획득적효익시기적9.9％～90.2％.결론 careHPV매5년사사1차시성본효과화효익최우적방안,가작위아국성향지구대범위추엄적자궁경암사사방안적최가선택.경제교호지구야가고필채용careHPV검측매3년사사1차.
Objective To explore the appropriate strategies which are suitable for the areas with diverse bealth and economic resource settings in China by estimating the life outcomes and cost-effectiveness of several cervical cancer screening strategies.Methods Markov model was used to calculate the long-term effectiveness,utility,benefit and cost among screened and unscreened cohorts in rural and urban areas,and then analyses of cost-effectiveness,cost-utility and cost-benefit were performed.The assessed screening strategies were acetic acid of visual inspection combined with Lugol's iodine staining (VIA/VILI),conventional Pap smear and simple HPV DNA testing (careHPV) in rural areas,and conventional Pap smear,simple HPV DNA testing (careHPV),HPV DNA testing (HC2) and liquid-based cytology (LBC) alone or combined with HPV DNA testing ( LBC + HC2) in urban areas.We estimated the life outcomes and cost-effectiveness of the above screening strategies at one-year,3-year and 5-year intervals.Results All of the screening strategies were effective to decrease cervical cancer mortality and to increase life years,with a trend of shorter screening interval having better effectiveness.However,no matter in urban or rural areas,compared with careHPV testing at 5-year interval,the costs of other screening strategies were 1.28-13.86 folds,1.31-14.14 folds,and 1.27-12.80 folds higher to avoid one death,to save a year of life,and a QALY,and the benefit per cost of other screening strategies was 9.9％-90.2％.Conclusions careHPV testing at 5-year interval has the best cost-effectiveness performance and the highest benefit-cost ratio with the moderate life outcomes.It is the optimal cervical cancer screening strategy to be generalized in our country.careHPV testing at 3 years interval can be considered in more developed areas to achieve better effectiveness.
