宫颈癌筛查方案的成本效果评价：基于江浙沪地区  

Cost-effectiveness evaluation of cervical cancer screening program:a study based on Jiangsu,Zhejiang and Shanghai Areas

作　　者：揭俊钦 金龙妹 陈丹妮 肖丽萍 蒋重阳[1] 姚雁 徐颖 周萍[1] JIE Jun-qin;JIN Long-mei;CHEN Dan-ni;XIAO Li-ping;JIANG Chong-yang;YAO Yan;XU Ying;ZHOU Ping(School of Public Health,Fudan University,Key Laboratory of Health Technology Assessment of National Health Commission(Fudan University),Shanghai 200032,China;Shanghai Minhang District Maternal and Child Health Hospital,Shanghai 201102,China)

机构地区：[1]复旦大学公共卫生学院,国家卫生健康委员会卫生技术评估重点实验室(复旦大学),上海200032 [2]上海市闵行区妇幼保健院,上海201102

出　　处：《中国卫生资源》2019年第3期175-179,203,共6页Chinese Health Resources

基　　金：上海市第四轮公共卫生三年行动计划重点学科建设项目(循证公共卫生与卫生经济学)(15GWZK0901);闵行区医学特色专科项目“妇女保健”(2017MWTZ19)

摘　　要：目的结合指南推荐和我国目前宫颈癌筛查的实践工作,从社会角度对6种宫颈癌筛查方案的成本效果进行评估。方法运用TreeAge Pro 2018软件构建Markov队列模型,模拟10万名初始年龄为15岁的健康妇女人群50年内的人乳头瘤病毒(human papillomavirus,HPV)感染、癌前病变到宫颈癌的病程,并对模拟的各筛查方案进行成本效果评价。结果6种筛查方案每2年、3年和5年1次的成本效果排序(从好到差)均依次为:HPV高危分型筛查、液基细胞学检测(thinprep cytologic test,TCT)联合HPV高危分型、HPV高危亚型筛查、巴氏细胞学检测(Pap cytologic test,PAP)联合HPV高危分型筛查、TCT、PAP。HPV高危分型每5年1次筛查成本效果最优。以江浙沪地区2018年人均国内生产总值(11.7万元)作参考,TCT联合HPV高危分型筛查每5年1次筛查相较于最优成本效果方案的增量成本效果比最小且可以被接受。结论从社会角度考虑,可优先考虑选择HPV高危分型每5年1次筛查。建议在经济条件允许的情况下,可以选择TCT联合HPV高危分型筛查每5年1次筛查。Objective Combined with the national/international guidelines and the current practice of cervical cancer screening in China,this study evaluated the cost-effectiveness of six cervical cancer screening programs.Methods Markov cohort models were constructed using TreeAge Pro 2018 software to simulate 50 years’lifespan of 100 000 healthy women aged 15 years with human papillomavirus(HPV)infection,precancerous lesions and cervical cancer using six screening strategies.The cost-effectiveness of each screening strategy was calculated.Results The cost-effectiveness rankings(from good to bad)for the six strategies in every two,three and five years were as follow(from the highest to the lowest):HPV high-risk type,thinprep cytologic test(TCT)and HPV high-risk type,HPV high-risk subtype,Pap cytologic test(PAP)and HPV high-risk type,TCT,and PAP.This ranking did not vary by the interval of the screening.Among all combinations of screening strategies and intervals,HPV high-risk type screening in every five years had the best cost-effectiveness.Considering that the per capita gross domestic product was 117 000 yuan in Jiangsu,Zhejiang and Shanghai in 2018,TCT and HPV high-risk type screening in every five years showed the lowest incremental cost-effectiveness ratio compared to the optimal cost-effectiveness strategy,and was acceptable.Conclusion From social perspective,this study suggested that HPV high-risk type in every five years should be considered as the most appropriate screening strategy in Shanghai.However,TCT and HPV high-risk type screening in every five years is recommended for individuals with better financial condition.

关 键 词：宫颈癌 筛查 成本效果分析 江苏省 浙江省 上海市 巴氏细胞学检测 液基细胞学检测 人乳头瘤病毒 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] R173