Health Economic Analysis Of Cervical Cancer Screening Strategies Based On Markov Model And Its Applications

Cervical cancer is the third most common cause of cancer after breast and colorectal cancer in women in the world. About 528000 women are diagnosed with cervical cancer and approximately 26000 women die of cervical cancer annually in the world, among which 85% occur in developing countries. Although convinced achievements were acquired in the past few decades, cervical cancer remains as acritical problem threatening women’s health in China. Cervical cancer screening as the main means of preventing cervical cancer is likely to continue for a long time. The recent application of high-throughput sequencing technology to HPV DNA detection or cervical cancer screening has emerged, but currently there is not health economics evaluation of cervical cancer screening by high-throughput sequencing for detection of HPV DNA. The objective in this study was to evaluate the long-term cost-effectiveness, cost-utility andcost-benefit of different strategies for HPV DNA testing based on high-throughput sequencing by using Markov modeling and simulation.In this study we use the population basic data from free cervical cancer screening programs carried out a medium-sized city in China in recent years; then use the Markov model combined with cervical cancer natural history and local screening interventions, it draw a conclusion that the natural development of population distribution and the screening&intervention development of population distribution; based on these population distribution combined with screening cost, make the next 20 years long-term cost-effectiveness analysis, cost-utility analysis and cost-benefit analysis.The results are that compared a no-screening strategy,the cost-effectiveness ratios of four interval screening strategies including every3 years, every 5 years, every 10 years and every 20 years of HPV DNA testing based on high-throughput sequencing, were5470.42 yuan/LYS, 4096.44 yuan/LYS, 3474.63 yuan/LYS, 2555.57yuan/LYS; the cost-utility ratios of fourinterval screening strategies were 4740.75 yuan /QALY, 3690.50 yuan/QALY, 3378.08 yuan/QALY, 8183.59 yuan/QALY; and the cost-benefit ratios of fourinterval screening strategies were 17.91, 23.42, 26.45, 11.19.The result datas of this study from cost-effectiveness analysis, cost-utility nalysis and cost-benefit analysis of HPV DNA testing based on high-throughput sequencing as cervical cancer screening method show that it brings the good results of the epidemiology and health economics. Among them, the best cost-effectiveness screening strategy was the one of the every 20 years interval(2555.57 yuan/LYS), the best cost-utility screening strategy was the one of the every 10 years interval(3378.08 yuan/QALY) and the best cost-benefit screening strategy was the one of the every 10 years interval(26.45). HPV DNA testing based on high-throughput sequencing for preliminary screening of cervical cancer screening program in the three aspects of cost-effectiveness, cost-utility and cost-benefit was not superior to the traditional Pap smear. However, only thinking about the effectiveness or utility of screening, HPV DNA testing based on high-throughput sequencing for preliminary screening of cervical cancer screening program was superior to the traditional Pap smear. In this study, the research results of health economics evaluation of HPV DNA testing based on high-throughput sequencing as cervical cancer screening method are valuable for the future application of HPV DNA testing based on high-throughput sequencing for small and medium-sized cities,and provide certain reference data and basis being favourable for the formulation of cervical cancer screening programme.