宫颈癌扩大筛检计划的成本效益分析

Cost-benefit of expanding cervical cancer screening

目的:探讨扩大宫颈癌筛检覆盖率计划是否具有成本效益。方法:利用浏阳市11年来的宫颈癌普查资料和浏阳市公共卫生综合试点调查资料,对现行的宫颈癌筛检和扩大筛检覆盖率的方案进行比较和成本效益分析。结果:采取扩大筛检计划后,浏阳市30～59岁已婚妇女的筛检覆盖率从7.20%上升至66.67%(u=17.84,P<0.001),每周期早期发现病例从20例增加到45例,避免减寿命年数从103.46增加至925.83个生命年。成本效益分析提示:多挽救1个寿命年平均需花费6 917.07元。从筛检的成本效益比来看,筛检覆盖率为66.67%时的效益成本比为1.80∶1,高于常规筛检的效益成本比1.40∶1,且两种方案均有较好的成本效益。结论:通过强化宣传,提前通知等方式,提高宫颈癌筛检的覆盖率,具有较好的成本效益。

Objective To estimate the benefit and cost of increasing the coverage of cervical cancer screening.Methods Using an eleven year conventional screening data（universal strategy） and a representative population sample（expanding strategy） to analyze the health and economic impact.Results The screening coverage for all 30-59 women in Liuyang was increased from 7.20% to 66.67%.Early detection cases were increased from 20 to 45,and life years saved in one screening term increased from 103.46 years to 925.83 years with expanding strategy as compared with the conventional strategy.The incremental cost per life year saved was 6 917.07 Yuan.The benifit/cost ratio was 1.80∶1 at the screening coverage of 66.67%,which was higher than that of the conventional strategy（1.40∶1）.Both strategies were cost-effective.Conclusion With various uncertainties and data limitations,expanding screening coverage is more effective than conventional strategy,and more benefit is obtained when the number of early detection cases increases.