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)×10(4) Yuan per life-year saved, cost-utility ratios ranged (0.15- 1.01)×10(4) 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.
目的： 探讨和评价适合中国农村地区的子宫颈癌筛查方案。 方法： 本研究依托中国2015年卫生行业科研专项"适合中国农村地区的子宫颈癌筛查技术与示范研究"建立筛查人群队列，收集卫生经济学和流行病学参数，采用Treeage Pro 2011软件建立未筛查组模型和筛查组模型。通过将现场调查获得的人群筛查、诊断、治疗的相关临床资料和成本数据代入模型，以模拟中国农村妇女在采用不同筛查方案干预后子宫颈癌的发生、发展，并预测20年后的筛查效果[包括累积发病率、累积发病风险、挽救的生命年和质量调整生命年（QALY）、收益]和相应的成本费用，并进行卫生经济学评价（包括成本效果分析、成本效用分析、成本效益分析）。子宫颈癌筛查方法有5种，包括醋酸或碘染色后肉眼观察（VIA/VILI）法、HPV快速筛查技术（careHPV）、液基薄层细胞学检查（TCT）、careHPV+TCT、careHPV+VIA/VILI，筛查间隔时间有3个，包括1年1次、3年1次和5年1次，共15种子宫颈癌筛查方案。 结果： 与未筛查组相比，15种子宫颈癌筛查方案可降低累积发病风险22.65%~51.76%。在同一筛查间隔时间，careHPV分别与TCT、VIA/VILI法比较，降低的累积发病风险、挽救的生命年、增加的QALY、收益均较高。15种子宫颈癌筛查方案的成本效果比为（0.44~3.24）万元/生命年，成本效用比为（0.15~1.01）万元/QALY，效益成本比为7.73~59.10。增量成本效果分析显示，优势方案有VIA/VILI法5年1次、VIA/VILI法3年1次、care HPV检测5年1次、careHPV检测3年1次和careHPV检测1年1次。 结论： VIA/VILI法筛查经济有效，careHPV成本稍高但效果更好。对于我国农村地区建议选择careHPV检测5年1次的筛查方案。本研究为确定适合中国农村地区的子宫颈癌筛查方法提供了依据。.
Keywords: Costs and cost analysis; Early detection of cancer; Markov chains; Uterine cervical neoplasms.