期刊
EUROPEAN JOURNAL OF CANCER PREVENTION
卷 25, 期 5, 页码 430-439出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/CEJ.0000000000000202
关键词
cervical cancer screening; cost-effectiveness; human papillomavirus virus DNA testing; vaccination
类别
资金
- Instituto de Salud Carlos III (ISCIII) [FIS PI11/02090]
- General Sub-Directorate for Research Assessment and Promotion of the European Regional Development Fund (FEDER)
- Spanish Cancer Network RTICC [RD12/0036/0056]
Human papillomavirus (HPV) vaccination within a nonorganized setting creates a poor cost-effectiveness scenario. However, framed within an organized screening including primary HPV DNA testing with lengthening intervals may provide the best health value for invested money. To compare the effectiveness and cost-effectiveness of different cervical cancer (CC) prevention strategies, including current status and new proposed screening practices, to inform health decision-makers in Spain, a Markov model was developed to simulate the natural history of HPV and CC. Outcomes included cases averted, life expectancy, reduction in the lifetime risk of CC, life years saved, quality-adjusted life years (QALYs), net health benefits, lifetime costs, and incremental cost-effectiveness ratios. The willingness-to-pay threshold is defined at 20 000(sic)/QALY. Both costs and health outcomes were discounted at an annual rate of 3%. A strategy of 5-year organized HPV testing has similar effectiveness, but higher efficiency than 3-year cytology. Screening alone and vaccination combined with cytology are dominated by vaccination followed by 5-year HPV testing with cytology triage (12 214(sic)/QALY). The optimal age for both ending screening and switching age from cytology to HPV testing in older women is 5 years later for unvaccinated than for vaccinated women. Net health benefits decrease faster with diminishing vaccination coverage than screening coverage. Primary HPV DNA testing is more effective and cost-effective than current cytological screening. Vaccination uptake improvements and a gradual change toward an organized screening practice are critical components for achieving higher effectiveness and efficiency in the prevention of CC in Spain. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.
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