摘要目的 探讨适合中国城镇地区经济可行的子宫颈癌筛查方案.方法 运用Markov模型模拟子宫颈癌筛查诊治过程,评价不同筛查方案的流行病学效果和卫生经济学效果.评价方案共24种,包括4种筛查方法[液基细胞学(LBC)、人乳头状瘤病毒(HPV) DNA分型、LBC与HPV DNA分型串联、LBC与HPV DNA分型并联]、3种筛查间隔(1、3、5年)和2种筛查起始年龄(30岁和35岁).模型参数来自中国城镇地区筛查项目和文献资料.结果 与未筛查组比较,各筛查方案子宫颈癌累计发病风险和死亡风险分别降低69％和82％以上.起始年龄35岁LBC 5年1次方案成本最低(690元/人)且较未筛查组能挽救人均生命年.各筛查方案较未筛查组每挽救1个生命年成本为-10 903～117 992元之间,均符合成本效果原则.增量成本效果分析结果显示,起始年龄30岁LBC 5年1次、LBC 3年1次、HPV DNA分型3年1次、LBC 1年1次为优势方案.结论 人群筛查可有效防治子宫颈癌,在我国城镇地区资源有限时可选择起始年龄35岁LBC 5年1次的筛查方案.资源条件允许的情况下,可依次考虑起始年龄30岁LBC 5年1次、LBC 3年1次、HPV DNA分型3年1次或LBC 1年1次的筛查方案.

abstractsObjective To explore the most economically feasible cervical cancer screening strategies in urban China.Methods A series of Markov models were constructed to evaluate health and economic outcomes of different screening strategies.There were 24 screening strategies including four screening methods:liquid-based cytology (LBC),human papillomavirus (HPV) DNA genotyping,HPV DNA genotyping with LBC triage (HPV DNA + LBC),HPV DNA genotyping and LBC co-testing (HPV DNA-LBC),along with three intervals (every 1,3 or 5 years) and two starting age for screening (30 or 35 years old) were compared.Models parameters were obtained from a cervical cancer screening study in urban China and literature reviews.Results The cumulative incidence and mortality risk of cervical cancer declined over 69％ and 82％ respectively for each screening strategy as compared with the no screening scenario.LBC every five years starting from 35 years old strategy cost the least (RMB 690 per capita) and could save life years compared with no screening.The cost effectiveness ratios of 24 strategies ranged from -10 903 to 117 992 RMB per life year saved.All strategies were cost-effective compared to no screening.In the incremental cost-effectiveness analysis,LBC every 5 years starting from 30 strategy,HPV DNA genotyping every 3 years starting from 30 strategy,LBC every 3 years starting from 30 strategy and LBC every year starting from 30 strategy were dominant strategies.Conclusions Screening can effectively prevent cervical cancer.In urban Chinese areas with insufficient socioeconomic resources,LBC every 5 years from 35 years old strategy is recommended.In relatively more affluent areas,LBC every 5 years from 30 years old strategy,LBC every 3 years from 30 years old strategy,HPV DNA genotyping every 3 years from 30 years old strategy,and LBC every year from 30 years old strategy are recommended successively.