Evaluation of primary HPV-DNA testing in relation to visual inspection methods for cervical cancer screening in rural China: an epidemiologic and cost-effectiveness modelling study

BMC Cancer

Research Article

Megan A Smith¹  Jie-Bin Lew¹  Leonardo Simonella²  Yoon-Jung Kang²  Karen Canfell²  Xiang-Xian Feng³  Fang-Hui Zhao⁴  You-Lin Qiao⁴  Ju-Fang Shi⁵  Jun-Feng Chen⁶  Li Ma⁶  Yan Ning⁶  Yong-Zhen Zhang⁷  Rosa Legood⁸ 

[1] Cancer Epidemiology Research Unit, Cancer Council NSW, 153 Dowling Street, Woolloomooloo 2011, New South Wales, Australia;Cancer Epidemiology Research Unit, Cancer Council NSW, 153 Dowling Street, Woolloomooloo 2011, New South Wales, Australia;School of Public Health, University of Sydney, Australia;Changzhi Medical College, 046000, Changzhi, Shanxi Province, China;Department of Cancer Epidemiology, Cancer Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, PO Box 2258, 17, South Panjiayuan LN, 100021, Beijing, China;Department of Cancer Epidemiology, Cancer Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, PO Box 2258, 17, South Panjiayuan LN, 100021, Beijing, China;Cancer Epidemiology Research Unit, Cancer Council NSW, 153 Dowling Street, Woolloomooloo 2011, New South Wales, Australia;School of Public Health, University of Sydney, Australia;School of Public Health, Dalian Medical University, 116044, Dalian, Liaoning Province, China;Shanxi Cancer Institute/Hospital, 030013, Taiyuan, Shanxi Province, China;The London School of Hygiene and Tropical Medicine, WC1E 7HT, London, United Kingdom;

关键词: Cervical Cancer;    Cervical Intraepithelial Neoplasia;    Shanxi Province;    Invasive Cervical Cancer;    Cervical Cancer Incidence;   

DOI  :  10.1186/1471-2407-11-239

 received in 2010-03-08, accepted in 2011-06-13,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundA new lower-cost rapid-throughput human papillomavirus (HPV) test (careHPV, Qiagen, Gaithersburg, USA) has been shown to have high sensitivity for the detection of high grade cervical intraepithelial neoplasia.MethodsWe assessed the outcomes and cost-effectiveness of careHPV screening in rural China, compared to visual inspection with acetic acid, when used alone (VIA) or in combination with Lugol's iodine (VIA/VILI). Using data on sexual behaviour, test accuracy, diagnostic practices and costs from studies performed in rural China, we estimated the cost-effectiveness ratio (CER) and associated lifetime outcomes for once-lifetime and twice-lifetime screening strategies, and for routine screening at 5-yearly, 10-yearly and IARC-recommended intervals. The optimal age range for once-lifetime screening was also assessed.ResultsFor all strategies, the relative ordering of test technologies in reducing cervical cancer incidence and mortality was VIA (least effective); VIA/VILI; careHPV@1.0 pg/ml and careHPV@0.5 pg/ml (most effective). For once-lifetime strategies, maximum effectiveness was achieved if screening occurred between 35-50 years. Assuming a participation rate of ~70%, once-lifetime screening at age 35 years would reduce cancer mortality by 8% (for VIA) to 12% (for careHPV@0.5) over the long term, with a CER of US$557 (for VIA) to $959 (for careHPV@1.0) per life year saved (LYS) compared to no intervention; referenced to a 2008 GDP per capita in Shanxi Province of $2,975. Correspondingly, regular screening with an age-standardised participation rate of 62% (which has been shown to be achievable in this setting) would reduce cervical cancer mortality by 19-28% (for 10-yearly screening) to 43-54% (using IARC-recommended intervals), with corresponding CERs ranging from $665 (for 10-yearly VIA) to $2,269 (for IARC-recommended intervals using careHPV@1.0) per LYS.ConclusionsThis modelled analysis suggests that primary careHPV screening compares favourably to visual inspection screening methodologies in rural China, particularly if used as part of a regular screening program.

【 授权许可】

Unknown   
© Shi et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.