Development And Health Economic Evaluation Of Cervical Cancer Screening Strategy Among Rural Women In Hubei Province

[Purpose] Under the premise of limited resources,it is necessary to comprehensively quantify and consider the financial input and health output of the free cervical cancer screening program in rural China,so as to further develop the cervical cancer screening strategy suitable for rural areas.From the perspective of health system,this study aims to design and explore the cervical cancer screening strategies suitable for promotion in rural areas.Conducting health economic evaluations of different strategies,to provide scientific basis and policy suggestions for the adjustment of cervical cancer screening strategies in Hubei Province.Budget impact analysis of the optimal screening plan will provide a reference for the budget formulation of cervical cancer screening program in rural areas.[Methods] Information of cervical cancer screening in Rural Hubei Province and relevant parameters were obtained from literature,on-site investigation and key insider consultation.By combining the four key screening elements of screening technology,screening age,screening interval and screening coverage,108 screening strategies had been constructed.Treeage Pro 2018 was used to build a Markov model to simulate the natural development of cervical cancer and the process under the intervention of different screening strategies.Health economics evaluation and budget impact analysis were also carried out from the perspective of health system,subsequently.[Results] Under the threshold of 3 times the per capita GDP of Hubei Province in2019,the most dominant strategy was the TCT screening every 5 years for women aged 25 to 64 years old with 30% coverage.The cost of cervical cancer that will occur in the next40 years using this strategy was about 13336.89 yuan at the individual level,and the average cost of saving 26.02 QALYs was about 512.67 yuan.Compared with no screening,the dominant strategy increased by an average of about 2.04 QALYs at the individual level.Under the same coverage,the cost of cervical cancer in the next 40 years of the optimal strategy in this study was only 128.36 yuan more than that of the current strategy,but it would save 2 more QALY at the individual level.The sensitivity analysis results showed that discount rates,health utility value,and screening cost had impact on the incremental cost-effectiveness ratio for cervical screening.After adjusting the factors,the result unchanged.Compared with the current strategy,the results of the budget impact analysis showed that the average annual screening expenditure required are reduced by 12.3 million to 40.98 million yuan.As coverage expands,the average annual savings will be greater.The cost savings were mainly due to the extension of screening interval.[Conclusions] The TCT screening strategy,which covers 30% of women aged 25 to64 years and is performed every 5 years,is most suitable for rural Hubei province.The undominated strategies suggest that,with the development of economy and the improvement of threshold,expanding coverage and increasing screening frequency will be the improvement direction of this strategy.On the basis of the current screening strategy in Hubei Province,this study suggests that the starting age of screening can be lowered to 25 years old,and the screening interval for the general population can be appropriately extended for horizontally expanding the coverage of screening.In the case of limited resources,the expansion of screening coverage should focus on the combination of fairness and efficiency.In addition to appropriately increasing financial investment,limited health resources should be given priority to those with a higher risk of HPV infection and a higher burden of death and disease.Increasing the coverage of eligible women receiving preventive screening once in their lifetime will result in a higher screening utility than focusing on increasing the frequency of screening for a small number of women.The demonstration,mobilization and education functions of national program should be laid emphasis.A long-term mechanism integrating cervical cancer screening,rescue and treatment should be well explored.The information collection,monitoring and evaluation,and quality control of screening programs should be emphasized and optimized.