title: [Effectiveness and health economic analysis of strategies on cervical cancer screening and early diagnosis and treatment].
abstract: OBJECTIVE
  To explore the appropriate strategies which are suitable for the areas with diverse health and economic resource settings in China by estimating the life outcomes and cost-effectiveness of several cervical cancer screening strategies.
  
  
  METHODS
  Markov model was used to calculate the long-term effectiveness, utility, benefit and cost among screened and unscreened cohorts in rural and urban areas, and then analyses of cost-effectiveness, cost-utility and cost-benefit were performed. The assessed screening strategies were acetic acid of visual inspection combined with Lugol's iodine staining (VIA/VILI), conventional Pap smear and simple HPV DNA testing (careHPV) in rural areas, and conventional Pap smear, simple HPV DNA testing (careHPV), HPV DNA testing (HC2) and liquid-based cytology (LBC) alone or combined with HPV DNA testing (LBC+HC2) in urban areas. We estimated the life outcomes and cost-effectiveness of the above screening strategies at one-year, 3-year and 5-year intervals.
  
  
  RESULTS
  All of the screening strategies were effective to decrease cervical cancer mortality and to increase life years, with a trend of shorter screening interval having better effectiveness. However, no matter in urban or rural areas, compared with careHPV testing at 5-year interval, the costs of other screening strategies were 1.28 - 13.86 folds, 1.31 - 14.14 folds, and 1.27 - 12.80 folds higher to avoid one death, to save a year of life, and a QALY, and the benefit per cost of other screening strategies was 9.9%-90.2%.
  
  
  CONCLUSIONS
  careHPV testing at 5-year interval has the best cost-effectiveness performance and the highest benefit-cost ratio with the moderate life outcomes. It is the optimal cervical cancer screening strategy to be generalized in our country. careHPV testing at 3 years interval can be considered in more developed areas to achieve better effectiveness.
authors.affiliation: Department of Cancer Epidemiology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
authors.forename: Fang-hui
authors.initials: FH
authors.lastname: Zhao
authors.forename: Jun-feng
authors.initials: JF
authors.lastname: Chen
authors.forename: Xiao-hong
authors.initials: XH
authors.lastname: Gao
authors.forename: Li-min
authors.initials: LM
authors.lastname: Gao
authors.forename: Qi-gui
authors.initials: QG
authors.lastname: Liu
authors.forename: Zhi-hua
authors.initials: ZH
authors.lastname: Liu
authors.forename: He
authors.initials: H
authors.lastname: Xu
authors.forename: Jun-fei
authors.initials: JF
authors.lastname: Ma
authors.forename: Li
authors.initials: L
authors.lastname: Ma
authors.forename: Xiao-ling
authors.initials: XL
authors.lastname: Xu
authors.forename: Shang-ying
authors.initials: SY
authors.lastname: Hu
authors.forename: Yan
authors.initials: Y
authors.lastname: Ning
authors.forename: Ju-fang
authors.initials: JF
authors.lastname: Shi
authors.forename: You-lin
authors.initials: YL
authors.lastname: Qiao
mesh_terms: D019342:Acetic Acid; D000328:Adult; D002681:China / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D003584:Cytological Techniques; D004279:DNA, Viral / Q000032:analysis; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods*; D005260:Female; D061809:Human Papillomavirus DNA Tests; D006801:Humans; D007454:Iodides; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D008954:Models, Biological; D015233:Models, Statistical; D065006:Papanicolaou Test; D019057:Quality-Adjusted Life Years; D012424:Rural Population; D014505:Urban Population; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology / Q000821:virology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000821:virology
chemical_list: D004279:DNA, Viral; D007454:Iodides; D019342:Acetic Acid; C010389:Lugol's solution