Objective:This study evaluated the feasibility of different cervical cancer screening strategies in urban China.Methods:A Markov model was constructed to simulate a hypothetical cohort of 100,000 females aged 30-59 ye...Objective:This study evaluated the feasibility of different cervical cancer screening strategies in urban China.Methods:A Markov model was constructed to simulate a hypothetical cohort of 100,000 females aged 30-59 years in a 20-year period.Screening strategies included liquid-based cytology(LBC)every three years,human papillomavirus(HPV)DNA testing every three and five years,respectively,and a combination of HPV DNA testing and LBC(HPV+LBC)every three and five years,respectively.Model outcomes included cumulative incidence over 20 years,cumulative risk of cervical cancer,costs,life year saved(LYS),quality-adjusted life years(QALYs)and benefits.The cost-effectiveness ratios(CERs),incremental cost-effectiveness ratios(ICERs),costutility ratios(CURs),and benefit-cost ratios(BCRs)were used as outcomes in the health economic evaluation analysis.Univariate sensitivity analyses were performed to examine the stability of the results.Results:The cumulative incidence of the five screening strategies ranged from 833.02 to 1,158.07 cases per100,000 females.HPV DNA testing was most effective in reducing the cumulative risk of cervical cancer,saving life years and QALYs and gaining benefits.The CERs of HPV DNA testing every three and five years,and LBC every three years were considered to be very cost-effective if they were below China's GDP per capita.The CERs of HPV+LBC were considered to be cost-effective if they were below three times GDP per capita.The incremental cost-effectiveness analysis showed that HPV DNA testing every three and five years,LBC every three years and HPV+LBC every five years were dominant strategies.Conclusions:The findings of this study indicated that HPV DNA testing every five years or LBC every three years should be recommended in urban China.展开更多
Objective To evaluate the economy of domestic bivalent human papilloma virus(HPV)vaccine,imported 9-valent HPV vaccine and 5 cervical cancer screening programs,and to provide a reference for relevant decision-making.M...Objective To evaluate the economy of domestic bivalent human papilloma virus(HPV)vaccine,imported 9-valent HPV vaccine and 5 cervical cancer screening programs,and to provide a reference for relevant decision-making.Methods A Markov model of the natural disease development of cervical cancer was constructed to simulate the cumulative long-term cost and quality-adjusted life years(QALYs)of one hundred thousand healthy women after they received different interventions for cost-effectiveness analysis.Results and Conclusion Compared with the non-intervention group,the cost of per QALY obtained by two HPV vaccines and 5 screening programs ranged from 1117.56 yuan to 71660.48 yuan.Taking China’s GDP per capita in 2020 as the threshold,two HPV vaccines and 5 screening programs are cost-effective.Domestic bivalent vaccine is cost-effective and it should be introduced to the national immunization program in the future.Different screening programs are all cost-effective,too.Among them,careHPV test once every 5 years has the lowest ICER value and it can be used as the first choice for cervical cancer screening in rural areas or resource-limited areas in China.展开更多
目的利用Markov模型对宫颈癌早诊治进行评价。方法运用Markov链的无记忆性,预测从现在开始20年的情况,以自然发展组作为对照组,分别计算了终身筛查一次、每2年筛查一次、第5年筛查一次的队列分布。结果每2年筛查一次与自然发展相比,20...目的利用Markov模型对宫颈癌早诊治进行评价。方法运用Markov链的无记忆性,预测从现在开始20年的情况,以自然发展组作为对照组,分别计算了终身筛查一次、每2年筛查一次、第5年筛查一次的队列分布。结果每2年筛查一次与自然发展相比,20年可以增加4286个质量调整生命年数(Quality-adjusted life year,QALY),减少5368个伤残调整寿命年(Disalility-adjusted life year,DALY),减少患病人数1418人,减少死亡人数3263人;筛查的累计患病率与累计死亡率与自然发展相比均有所下降。结论应用Markov模型可以对疾病的早诊治作卫生经济学评价,从而制定出适宜特定人群的有效的筛查方案,为决策者提供决策依据。展开更多
目的对低剂量螺旋CT(LDCT)用于高危人群肺癌筛查进行卫生经济学评价,探讨在中国开展LDCT肺癌筛查的适宜年龄。方法基于2018年在四川省开展的肺癌筛查及早诊早治项目,运用TreeAge Pro 2011构建Markov模型,模拟肺癌筛查诊治过程,进行LDCT...目的对低剂量螺旋CT(LDCT)用于高危人群肺癌筛查进行卫生经济学评价,探讨在中国开展LDCT肺癌筛查的适宜年龄。方法基于2018年在四川省开展的肺癌筛查及早诊早治项目,运用TreeAge Pro 2011构建Markov模型,模拟肺癌筛查诊治过程,进行LDCT筛查策略下的卫生经济学效果评价。模型参数来自于四川省肺癌筛查及早诊早治项目和文献资料。结果与未筛查组进行比较,筛查起始年龄为50、55、60、65和70岁的筛查方案挽救的生命年分别为1977.60、2211.37、2483.34、2336.90和425.23年/10万人,其中60岁组最高。与未筛查组进行比较,各个年龄段开始筛查均符合成本效果原则,其中筛查年龄为50岁组的筛查方案每挽救1个生命年的所需成本最高,增量成本效果比为2397.94元/年;筛查年龄为70~74岁组的筛查方案每挽救1个生命年的成本低于未筛查组,增量成本效果比为-86.49元/年。60岁组和65岁组的筛查方案具有优势,其增量成本效果比依次为6482.13和517.62元/年,65岁组中筛查方案多挽救1个生命年所需的增量成本相对更低。与未筛查组相比较,各个年龄段的筛查方案使肺癌的发病和死亡风险分别降低24%和21%以上。结论1年1次的LDCT检查在各筛查年龄组均符合成本效果原则,但筛查年龄为60岁组和65岁组方案更具有优势。展开更多
基金supported by the National Health Commission of the People’s Republic of China (formerly the Health and Family Planning Commission) of China (No. 201502004)
文摘Objective:This study evaluated the feasibility of different cervical cancer screening strategies in urban China.Methods:A Markov model was constructed to simulate a hypothetical cohort of 100,000 females aged 30-59 years in a 20-year period.Screening strategies included liquid-based cytology(LBC)every three years,human papillomavirus(HPV)DNA testing every three and five years,respectively,and a combination of HPV DNA testing and LBC(HPV+LBC)every three and five years,respectively.Model outcomes included cumulative incidence over 20 years,cumulative risk of cervical cancer,costs,life year saved(LYS),quality-adjusted life years(QALYs)and benefits.The cost-effectiveness ratios(CERs),incremental cost-effectiveness ratios(ICERs),costutility ratios(CURs),and benefit-cost ratios(BCRs)were used as outcomes in the health economic evaluation analysis.Univariate sensitivity analyses were performed to examine the stability of the results.Results:The cumulative incidence of the five screening strategies ranged from 833.02 to 1,158.07 cases per100,000 females.HPV DNA testing was most effective in reducing the cumulative risk of cervical cancer,saving life years and QALYs and gaining benefits.The CERs of HPV DNA testing every three and five years,and LBC every three years were considered to be very cost-effective if they were below China's GDP per capita.The CERs of HPV+LBC were considered to be cost-effective if they were below three times GDP per capita.The incremental cost-effectiveness analysis showed that HPV DNA testing every three and five years,LBC every three years and HPV+LBC every five years were dominant strategies.Conclusions:The findings of this study indicated that HPV DNA testing every five years or LBC every three years should be recommended in urban China.
文摘Objective To evaluate the economy of domestic bivalent human papilloma virus(HPV)vaccine,imported 9-valent HPV vaccine and 5 cervical cancer screening programs,and to provide a reference for relevant decision-making.Methods A Markov model of the natural disease development of cervical cancer was constructed to simulate the cumulative long-term cost and quality-adjusted life years(QALYs)of one hundred thousand healthy women after they received different interventions for cost-effectiveness analysis.Results and Conclusion Compared with the non-intervention group,the cost of per QALY obtained by two HPV vaccines and 5 screening programs ranged from 1117.56 yuan to 71660.48 yuan.Taking China’s GDP per capita in 2020 as the threshold,two HPV vaccines and 5 screening programs are cost-effective.Domestic bivalent vaccine is cost-effective and it should be introduced to the national immunization program in the future.Different screening programs are all cost-effective,too.Among them,careHPV test once every 5 years has the lowest ICER value and it can be used as the first choice for cervical cancer screening in rural areas or resource-limited areas in China.
文摘目的利用Markov模型对宫颈癌早诊治进行评价。方法运用Markov链的无记忆性,预测从现在开始20年的情况,以自然发展组作为对照组,分别计算了终身筛查一次、每2年筛查一次、第5年筛查一次的队列分布。结果每2年筛查一次与自然发展相比,20年可以增加4286个质量调整生命年数(Quality-adjusted life year,QALY),减少5368个伤残调整寿命年(Disalility-adjusted life year,DALY),减少患病人数1418人,减少死亡人数3263人;筛查的累计患病率与累计死亡率与自然发展相比均有所下降。结论应用Markov模型可以对疾病的早诊治作卫生经济学评价,从而制定出适宜特定人群的有效的筛查方案,为决策者提供决策依据。
文摘目的对低剂量螺旋CT(LDCT)用于高危人群肺癌筛查进行卫生经济学评价,探讨在中国开展LDCT肺癌筛查的适宜年龄。方法基于2018年在四川省开展的肺癌筛查及早诊早治项目,运用TreeAge Pro 2011构建Markov模型,模拟肺癌筛查诊治过程,进行LDCT筛查策略下的卫生经济学效果评价。模型参数来自于四川省肺癌筛查及早诊早治项目和文献资料。结果与未筛查组进行比较,筛查起始年龄为50、55、60、65和70岁的筛查方案挽救的生命年分别为1977.60、2211.37、2483.34、2336.90和425.23年/10万人,其中60岁组最高。与未筛查组进行比较,各个年龄段开始筛查均符合成本效果原则,其中筛查年龄为50岁组的筛查方案每挽救1个生命年的所需成本最高,增量成本效果比为2397.94元/年;筛查年龄为70~74岁组的筛查方案每挽救1个生命年的成本低于未筛查组,增量成本效果比为-86.49元/年。60岁组和65岁组的筛查方案具有优势,其增量成本效果比依次为6482.13和517.62元/年,65岁组中筛查方案多挽救1个生命年所需的增量成本相对更低。与未筛查组相比较,各个年龄段的筛查方案使肺癌的发病和死亡风险分别降低24%和21%以上。结论1年1次的LDCT检查在各筛查年龄组均符合成本效果原则,但筛查年龄为60岁组和65岁组方案更具有优势。
