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Cost-effectiveness of the screen-and-treat strategies using HPV test linked to thermal ablation for cervical cancer prevention in China: a modeling study.
Zhao, Xue-Lian; Zhao, Shuang; Xia, Chang-Fa; Hu, Shang-Ying; Duan, Xian-Zhi; Liu, Zhi-Hua; Wang, Yue-Yun; You, Ting-Ting; Gao, Meng; Qiao, You-Lin; Basu, Partha; Zhao, Fang-Hui.
Afiliación
  • Zhao XL; Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
  • Zhao S; Department of Clinical Trial Research Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
  • Xia CF; Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
  • Hu SY; Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
  • Duan XZ; Department of Obstetrics and Gynecology, Beijing Tongren Hospital, Beijing, China.
  • Liu ZH; Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China.
  • Wang YY; Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China.
  • You TT; Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
  • Gao M; Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
  • Qiao YL; School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
  • Basu P; School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
  • Zhao FH; Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France.
BMC Med ; 21(1): 149, 2023 04 17.
Article en En | MEDLINE | ID: mdl-37069602
BACKGROUND: Self-sampling HPV test and thermal ablation are effective tools to increase screening coverage and treatment compliance for accelerating cervical cancer elimination. We assessed the cost-effectiveness of their combined strategies to inform accessible, affordable, and acceptable cervical cancer prevention strategies. METHODS: We developed a hybrid model to evaluate costs, health outcomes, and incremental cost-effectiveness ratios (ICER) of six screen-and-treat strategies combining HPV testing (self-sampling or physician-sampling), triage modalities (HPV genotyping, colposcopy or none) and thermal ablation, from a societal perspective. A designated initial cohort of 100,000 females born in 2015 was considered. Strategies with an ICER less than the Chinese gross domestic product (GDP) per capita ($10,350) were considered highly cost-effective. RESULTS: Compared with current strategies in China (physician-HPV with genotype or cytology triage), all screen-and-treat strategies are cost-effective and self-HPV without triage is optimal with the most incremental quality-adjusted life-years (QALYs) gained (220 to 440) in rural and urban China. Each screen-and-treat strategy based on self-collected samples is cost-saving compared with current strategies (-$818,430 to -$3540) whereas more costs are incurred using physician-collected samples compared with current physician-HPV with genotype triage (+$20,840 to +$182,840). For screen-and-treat strategies without triage, more costs (+$9404 to +$380,217) would be invested in the screening and treatment of precancerous lesions rather than the cancer treatment compared with the current screening strategies. Notably, however, more than 81.6% of HPV-positive women would be overtreated. If triaged with HPV 7 types or HPV16/18 genotypes, 79.1% or 67.2% (respectively) of HPV-positive women would be overtreated with fewer cancer cases avoided (19 cases or 69 cases). CONCLUSIONS: Screen-and-treat strategy using self-sampling HPV test linked to thermal ablation could be the most cost-effective for cervical cancer prevention in China. Additional triage with quality-assured performance could reduce overtreatment and remains highly cost-effective compared with current strategies.
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Texto completo: 1 Base de datos: MEDLINE Asunto principal: Displasia del Cuello del Útero / Neoplasias del Cuello Uterino / Infecciones por Papillomavirus Tipo de estudio: Diagnostic_studies / Health_economic_evaluation / Prognostic_studies / Screening_studies Límite: Child / Female / Humans Idioma: En Revista: BMC Med Asunto de la revista: MEDICINA Año: 2023 Tipo del documento: Article País de afiliación: China

Texto completo: 1 Base de datos: MEDLINE Asunto principal: Displasia del Cuello del Útero / Neoplasias del Cuello Uterino / Infecciones por Papillomavirus Tipo de estudio: Diagnostic_studies / Health_economic_evaluation / Prognostic_studies / Screening_studies Límite: Child / Female / Humans Idioma: En Revista: BMC Med Asunto de la revista: MEDICINA Año: 2023 Tipo del documento: Article País de afiliación: China