Health Economic Evaluation And Economic Feasibility Research Of Cervical Cancer Screening In Rural

Objective:To determine the optimal screening strategies under different economic conditions through comparing different cervical cancer screening strategies by health economic evaluation, and to analyze economic feasibility by calculating the cost of per capital each time about optimal screening strategies, and combining with data from related project, which provide evidence for implementation of cervical cancer screening in rural areas and establishment of a rational feasible cost-sharing mechanism.Methods:Fitting a population of 100 thousands women aged 30-59 as the object based on the age-specific compositions of women aged 30-59 from the fifth national census, combined with the parameters from previous research and published literature, Markov model is constructed with Tree Age Pro 2009. The health economic evaluation is undertaken to determine optimal screening strategies and calculate the cost of per capital each time about optimal screening strategies. At the same time, one-way sensitivity analysis is used to analyze the variables that may affect the decision-making.Results:①Over 20 years, comparing with unscreening, different cervical cancer screening strategies for the 100 thousands women will bring about health expenditure from￥421.6 thousands toY303.1735 millions, and reduce the cumulative incidence of cervical cancer by from 2.91%to 50.62%, and save 257.33 to 3531.69 life years saved(LYS),512.63 to 9651.84 qualified adjusted life years(QALYs), and also bring about benefit from￥8.3445 million to￥11.66985 million.②Among different cervical cancer screening strategies, the cost of per LYS range from￥1421.45 to￥85843.66, and the cost of per QALYs range from￥678.75 toY31410.94, and the benefit yield each￥1 input was from￥0.38 to￥22.51. Among different screening strategies,10- yearly VIA/VILI testing(cost-effectiveness ratio(CER),￥1421.45/LYS) is the most effective strategy, and the CER of all of screening intervals LBC+ HPV testing is higher than China's per capita GDP.③On the basis of 10-yearly VIA/VILI testing, incremental cost-effectiveness analysis (ICEA) is carried out among ten screening strategies which are cost effective and have better effect than 10-yearly VIA/VILI testing. The ICER range from￥3499.04/LYS to￥20173.00/LYS. The optimal strategies under different economic conditions are determined according to the ICER, which is 10-yearly VIA/VILI testing,5-yearly VIA/VILI testing,3-yearly VIA/VILI testing,1-yearly VIA/VILI testing and 1-yearly Care HPV testing successively.④Among the five optimal screening strategies, the cost of VIA/VILI testing per capital each time range from￥10.81 to￥11.95, and the cost of Care HPV testing per capital each time is Y42.83.Conclusions:①It is cost effective for cervical cancer screening, which can reduce the incidence and the burden of cervical cancer.②We recommend the 10-yearly VIA/VILI testing where resources are scarce, while the 5-yearly VIA/VILI testing,3-yearly VIA/VILI testing,1-yearly VIA/ VILI testing and 1-yearly Care HPV testing successively where resources are affluent.③The cost-effectiveness of screening can be improved by reducing screening and treatment costs or raising the discount rate or enhancing the sensitivity of screening techniques or enlarging the screening coverage.④The Markov model is relatively stable and reliable by one way sensitivity analysis.⑤Along with low development and payment ability in some rural areas of China, it is difficult to guarantee the implementation of cervical cancer screening only by out of pocket payment.