摘要
目的针对无锡地区以人乳头瘤病毒(human papillomavirus,HPV)DNA分型检测为基础的宫颈癌筛查进行卫生经济学评价。方法运用Markov模型对2013年无锡市185 328名妇女以HPV基因分型检测为基础的宫颈癌筛查数据进行预测,预测之后10年的情况,以自然发展组为对照,计算终身筛查一次、每3年筛查一次、每5年筛查一次的队列分布,结合筛查费用及治疗费用分析评价成本效果、成本效益和成本效用等卫生经济学指标。结果终身筛查一次、每3年筛查一次和每5年筛查一次与自然发展相比,10年可以累计增加的质量调整生命年(quality adjusted life year,QALY),分别是481.75、2 865.35、1 949.84;CIN2以上患病率分别降低了4.90%、42.26%、28.06%;死亡率分别降低了1.13%、2.03%、1.59%;每挽救一个生命年的成本分别是30 991.30元、70 612.81元、55 654.18元;每挽救1个质量调整生命年的成本分别是19 234.9元、11 311.5元、10 817.8元;每投入1个单位成本所获得的效益分别是3.04、5.27、5.55。结论每5年筛查一次的方案比较适合无锡这种中小城市的宫颈癌防控。
Objective To evaluate the cervical cancer screening performance in Wuxi city based on human papillomavirus（HPV）DNA genotyping detection. Methods The Markov model was adopted to predict situations in the next ten years according to the cervical cancer screening data collected from 185 328 women in Wuxi in 2013 and processed based on HPV genotyping detection.Using unscreened women as control,data for women being screened once in a life time,once every three years and once every five years were individually calculated.In combination with screening and treatment expenses,health economics index such as cost effectiveness,cost benefit and cost utility were analyzed and compared. Results Compared with control group,screening once in a life time,once every three years and once every five years could add up 481.75,2 865.35 and 1 949.84 quality adjusted life years（QALYs）,respectively.The prevalence of CIN2 and above decreased by 4.90%,42.26%,28.06% and mortality reduced by 1.13%,2.03%,1.59%,respectively.The costs of a life year saved were 30 991.30,70 612.81 and 55 654.18 RMB for each screening strategies above.The costs per QALY were 19 234.9for screening once in a life time,11 311.5for screening once every three years and 10 817.8for screening once every five years.Meanwhile,the benefits achieved from each unit cost invested were 3.04,5.27 and 5.55,respectively. Conclusions Considering the health economics effectiveness,it is suggested that every five years screening interval based on HPV DNA genotyping detection is suitable to a small and medium-sized city like Wuxi.
出处
《中国预防医学杂志》
CAS
2015年第11期848-853,共6页
Chinese Preventive Medicine
基金
国家自然科学基金青年科学基金项目(81202043)
南京市科技计划项目(2013创基025)
