CAJ | 학술논문

目的对宫颈癌多种筛查方案终生筛查一次的效果进行卫生经济学评价,并探讨最具有成本效果的筛查起始年龄.方法在农村地区选择醋酸/碘染色肉眼观察检查(VIA/VILI)、传统巴氏细胞学检测(Pap Smear)和简易人乳头瘤病毒(HPV) DNA检测(careHPV)3种筛查方法,城市地区选择PAP Smear、液基细胞学检测(LBC)、careHPV、HPV DNA检测(HC2)和LBC联合HC2检测(LBC+HC2)5种筛查方法.运用Markov模型,预测在不同筛查起始年龄终生筛查一次的远期流行病学和卫生经济学效果.结果在农村和城市地区,各筛查方案队列人群20年后挽救的累积生命年分别为277.97年/10万人至2727.53年/10万人和134.02年/10万人至1446.84年/10万人；与对照组相比,各筛查方案每挽救一个生命年的成本分别在1520.99 ～ 2453.74元和3847.35～44 570.35元之间；增量成本效果分析显示,农村地区的优势方案依次为careHPV 40岁和careHPV 30岁起始筛查方案,城市地区的优势方案依次为careHPV 40岁、careHPV 30岁、HC2 30岁和LBC+HC2 30岁起始筛查方案.结论如妇女终生接受一次筛查,农村和城市地区所有评价方案均具有成本效果,careHPV 40岁起始筛查是中国农村和城市地区最具有成本效果的筛查方案.
목적 대궁경암다충사사방안종생사사일차적효과진행위생경제학평개,병탐토최구유성본효과적사사기시년령.방법 재농촌지구선택작산/전염색육안관찰검사(VIA/VILI)、전통파씨세포학검측(Pap Smear)화간역인유두류병독(HPV) DNA검측(careHPV)3충사사방법,성시지구선택PAP Smear、액기세포학검측(LBC)、careHPV、HPV DNA검측(HC2)화LBC연합HC2검측(LBC+HC2)5충사사방법.운용Markov모형,예측재불동사사기시년령종생사사일차적원기류행병학화위생경제학효과.결과 재농촌화성시지구,각사사방안대렬인군20년후만구적루적생명년분별위277.97년/10만인지2727.53년/10만인화134.02년/10만인지1446.84년/10만인；여대조조상비,각사사방안매만구일개생명년적성본분별재1520.99 ～ 2453.74원화3847.35～44 570.35원지간；증량성본효과분석현시,농촌지구적우세방안의차위careHPV 40세화careHPV 30세기시사사방안,성시지구적우세방안의차위careHPV 40세、careHPV 30세、HC2 30세화LBC+HC2 30세기시사사방안.결론 여부녀종생접수일차사사,농촌화성시지구소유평개방안균구유성본효과,careHPV 40세기시사사시중국농촌화성시지구최구유성본효과적사사방안.
Objective To estimate the cost-effectiveness of once-in-a-lifetime cervical cancer screening program and to predict the optimal modality for its operation on women living in rural and urban areas of China,based on Markov modeling and simulation.Methods Three modalities including visual inspection with acetic acid plus Lugol' s iodine (VIA/VILI),conventional Pap Smear (Pap Smear),and simple HPV DNA testing (careHPV) were hypothesized for the rural cohort,whereas other five modalities including Pap Smear,liquid-based cytology (LBC),simple HPV DNA testing (careHPV),Hybrid Capture 2 HPV DNA testing (HC2),and LBC plus HC2 (LBC +±HC2) were tested for the urban cohort.A Markov model was constructed based on the factors as natural history,screening,diagnosis and treatment on cervical cancer using data related to the epidemics and the costs from rural and urban areas of the country.Long-term effectiveness and cost-effectiveness were predicted through simulation of the model.Results Compared to the non-screening scenario,the amount of life years saved were 277.97-2727.53 and 134.02-1446.84years per 100 000 women,respectively,for different cohorts in rural and urban areas.The cost effectiveness ratios were 1520.99-2453.74 and 3847.35-44 570.35 RMB per life year saved,respectively,for different cohorts in rural and urban areas.The incremental cost-effective ratio for careHPV starting from 40 years old (careHPV@40) and careHPV from 30 years old (careHPV@30)dominated other strategies for the rural cohort,while careHPV@40,careHPV@30,HC2 from 30 years old (HC2@30),and LBC + HC2 from 30 years old (LBC +-HC2@30) were dominant for the urban cohort.Conclusion All eight once-in-a-lifetime cervical cancer screening modalities were cost-effective based on our model.In particular,careHPV screening starting from 40 years old seemed to be the most cost-effective one for women living in both rural and urban areas.