Health Economics Evaluation Of Women Cervical Cancer Screening Program In Urban Areas Of China

Objectives:Comparing the three screening technologies that HPV DNA testing,cytological testing and co-testing every 3 years,every 5 years and every 10 years,we can predict the effect after 20 years and health economics evaluation.Exploring the appropriate cervical cancer screening programs for different economic levels,we would provide scientific basis for decision makers to make screening strategies.Methods:We carried out urban women cervical cancer screening by using the three screening technologies that HPV DNA testing,cytological testing and co-testing.Markov model was established to simulate natural history and screening history of cervical cancer.Relevant data about epidemiological and costs of screening and treatment will be put into Markov model to predict the long-term effects and economic evaluation such as cost effectiveness analysis,cost effectiveness utility and cost benefit analysis.Results: Comparing with no screening,these screening strategies will save 4507.07~13637.44 life years/ 100,000 people and 19737.47~47937.00 QALYs / 100,000 people.At the same screening intervals,the saved life years and QALYs are at least as followed by co-testing,HPV DNA testing and cytological testing.In these screening methods,the saved life years and QALYs of every 3 years are higher than every 5 years and every 10 years.That means with the extension of the screening interval,screening effect and utility is gradually reduced.Cost effectiveness analysis show that the cost is 17434.72~41569.74 RMB per life year saved and cost effectiveness utility showed that the cost of a QALY saved is 5457.00~11826.04 RMB.All cervical cancer screening modalities are cost-effective based on our model according to WHO.At the same screening intervals,the cost of co-testing that saved a life and a QALY is the highest than HPV DNA testing and cytological testing.At the same screening method,the saved a life year and a QALY by every 10 years will pay more cost than other screening intervals.The best cervical cancer screening programs are cytology testing every 10 years,HPV DNA testing once every 5 years,HPV DNA testing every 3 years and co-testing every 3 years.Cost benefit analysis show that HPV DNA testing will get 3.98~4.44 benefits per cost,higher than cytology testing and co-testing.Using the same screening method,the cost benefit analysis show that every 5 years is higher than other screening intervals.Conclusions:When using China's per capita GDP as threshold,all strategies evaluated in our model are very cost-effective.The cost-effective screening programs are cytology testing every 10 years,HPV DNA testing every 5 years,HPV DNA testing every 3 years and co-test every 3 years.Cytology testing costs are relatively low,and can be used in the more backward areas of economic development.In the economically developed areas,we will advise to choose cytology testing every 10 years or HPV DNA testing every 5 years.In the more affluent areas,it is recommended to use HPV DNA testing every 3 years or co-testing every 3 years.This study offered evidence for the decision makers to choose most effective and cost-effective cervical screening strategy in urban China.