Economic evaluation of cervical cancer screening strategies in urban China

Ma, Li; Wang, Yuying; Gao, Xiaoya; Dai, Yi; Zhang, Yu; Wang, Zhaojing; Wang, Xiaoxia; Wang, Limin; Jiang, Jing; Jing, Xinhua; Yang, Chunxia; Zhao, Fen; Lang, Jinghe; Qiao, You‐Lin

doi:10.21147/j.issn.1000-9604.2019.06.13

Cited by 9 publications

(11 citation statements)

References 29 publications

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“…Cost-effectiveness evaluation showed that conducting low-cost hrHPV testing every 3 to 5 years in rural areas and hrHPV testing every 5 years in urban areas was cost-effective. 14,15 Polymerase chain reaction-based hrHPV genotyping for urban areas and hybrid capture-based hrHPV testing for rural areas are effective screening modalities in primary health care centers.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of High-risk Human Papillomavirus Testing for Cervical Cancer Screening in China

et al. 2021

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IMPORTANCEEvidence is needed regarding the introduction of high-risk human papillomavirus (hrHPV) testing into China's national cervical cancer screening program.OBJECTIVE To evaluate hrHPV testing as a new screening modality for the national program. DESIGN, SETTING, AND PARTICIPANTSThis population-based, multicenter, open-label, randomized clinical trial took place across 20 primary health care centers in urban and rural areas across China. At least 3000 women aged 35 to 64 years per site were invited to participate, for a total of 60 732 women evaluated.INTERVENTIONS At baseline, women were randomly assigned to cytology, hrHPV testing, or visual inspection with acetic acid and Lugol iodine (VIA/VILI) (rural only). Women who tested positive for hrHPV were randomized into cytology-triage, VIA/VILI-triage (rural only), or direct colposcopy arms. Regarding primary or triaging tests, women with cytological abnormalities or who tested positive with VIA/VILI were referred to colposcopy. After 24 months, combined screening of cytology, hrHPV testing, and VIA/VILI was performed, and all women with positive results were referred to colposcopy. MAIN OUTCOMES AND MEASURESThe primary outcomes were cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and CIN3+ yields. The secondary outcome was colposcopy referral rate.RESULTS A total of 60 732 women were included in this study, with median (interquartile range) age of 47 (41-52) years. Among urban women, 8955 were randomized to cytology and 18 176 to hrHPV genotyping; among rural women, 11 136 were randomized to VIA/VILI, 7080 to cytology, and 15 385 to hrHPV testing. Participants who tested positive for hrHPV with direct colposcopy had higher risk ratios for disease yields at baseline (urban hrHPV vs cytology, CIN2+ 2.2 [95% CI, 1.6-3.2] and CIN3+ 2.0 [95% CI, 1.2-3.3]; rural hrHPV vs cytology, 2.6 [95% CI, 1.9-4.0] and 2.7 [95% CI, 2.0-3.6]; rural hrHPV vs VIA/VILI, 2.0 [95% CI, 1.6-2.3] and 2.3 [95% CI, 1.8-3.1]). At 24 months, baseline-negative women in the hrHPV arm had significantly lower risk ratios than those with cytology, or VIA/VILI for CIN2+ (0.3 [95% CI, 0.2-0.5], 0.3 [95% CI, 0.2-0.6]) and CIN3+ (0.3 [95% CI, 0.1-0.6], 0.4 [95% CI, 0.2-0.8]) in rural sites. The colposcopy referral rate for hrHPV-positive rural women was reduced to 2.8% by cytology triage, with significantly higher CIN2+ yields than cytology (2.1 [95% CI, 1.3-2.6]) or VIA/VILI arm (1.6 [95% CI, 1.03-2.1]). Genotyping for hrHPV with cytology triage significantly reduced the colposcopy referral rate compared with cytology (0.8 [95% CI, 0.7-0.9]) for urban women. CONCLUSIONS AND RELEVANCEIn this randomized clinical trial, testing for hrHPV was an effective primary screening method in primary health care centers. Incorporating hrHPV testing (polymerase chain reaction-based for urban areas, hybrid capture-based for rural areas) into China's national screening program is reasonable.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of High-risk Human Papillomavirus Testing for Cervical Cancer Screening in China

et al. 2021

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“…In China, the incidence and mortality of cervical cancer in rural areas are significantly higher than those in cities, and economically backward areas are significantly higher than those in economically developed areas. Furthermore, there has been a continuous upward trend in the past 20 years 23. From 2000 to 2014, the average annual growth rate of cervical cancer incidence in China reached 10.5%, and the age of onset showed a younger trend.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, there has been a continuous upward trend in the past 20 years. 23 From 2000 to 2014, the average annual growth rate of cervical cancer incidence in China reached 10.5%, and the age of onset showed a younger trend. Fortunately, China has made remarkable achievements in cervical cancer prevention and management.…”

Section: Discussionmentioning

confidence: 99%

Global trends and age-specific incidence and mortality of cervical cancer from 1990 to 2019: an international comparative study based on the Global Burden of Disease

Yang

Du²,

Liu³

et al. 2022

BMJ Open

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ObjectiveTo describe the trends of incidence and mortality of cervical cancer in different age groups and regions from 1990 to 2019.DesignAn international comparative study based on the Global Burden of Disease (GBD) study estimates.ParticipantsData were publicly available and individuals were not involved.MethodsWe collected detailed information on cervical cancer from the GBD study between 1990 and 2019. Average annual percentage changes (AAPCs) of age-standardised incidence and mortality rate (ASIR and ASMR) in cervical cancer, by age group and region, were calculated to quantify the temporal trends.ResultsGlobally, the absolute numbers of incident cases and deaths were increasing, with the most cervical cancer cases and deaths being reported in China, India and Brazil. Although the ASIR and ASMR have declined overall from 1990 to 2019, an increasing or stable trend was also observed in East Asia and Southern sub-Saharan Africa. Particularly, we found that the age-specific AAPC of incidence showed an increasing trend in the age group of 15–49 years globally, and the high Sociodemographic Index region increased the most.ConclusionsCervical cancer remains a concerning disease that affects women all over the world, although the ASIR and ASMR are decreasing. Efforts to control the younger trend and to reduce the disparity between regions are imminent.

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“…Base-case estimates and ranges for all parameters are listed in tables in the supplementary file (Additional file 2: Table S2) [2,3,14,19,26,28,[30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]. We assumed that infection-acquired immunity would wane over time, whereas vaccine-acquired immunity would be lifelong [2,3,40,52].…”

Section: Inputs and Assumptionsmentioning

confidence: 99%

Effectiveness and cost-effectiveness of eliminating cervical cancer through a tailored optimal pathway: a modeling study

Xia

Zhao

et al. 2021

BMC Med

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Background The World Health Assembly has adopted a global strategy to eliminate cervical cancer. However, neither the optimal pathway nor the corresponding economic and health benefits have been evaluated. We take China as an example to assess the optimal pathway towards elimination and the cost-effectiveness of tailored actions. Methods A validated hybrid model was used to assess the costs and benefits of alternative strategies combining human papillomavirus vaccination, cervical screening, and treatment of pre-invasive lesions and invasive cancer for females with different immunization history. All Chinese females living or projected to be born during 2015–2100, under projected trends in aging, urbanization, and sexual activity, were considered. Optimal strategies were determined by cost-effectiveness efficiency frontiers. Primary outcomes were cervical cancer cases and deaths averted and incremental cost-effectiveness ratios (ICERs). We employed a lifetime horizon from a societal perspective. One-way and probabilistic sensitivity analyses evaluate model uncertainty. Results The optimal pathway represents an integration of multiple tailored strategies from females with different immunization history. If China adopts the optimal pathway, the age-standardized incidence of cervical cancer is predicted to decrease to fewer than four new cases per 100,000 women (i.e., elimination) by 2047 (95% confidence interval 2043 to 2050). Compared to the status quo, the optimal pathway would avert a total of 7,509,192 (6,922,744 to 8,359,074) cervical cancer cases and 2,529,873 (2,366,826 to 2,802,604) cervical cancer deaths in 2021–2100, with the discounted ICER being $− 339 (− 687 to − 79) per quality-adjusted life-year. Conclusions By adopting an optimal pathway from 2021 (namely, the year of the first Chinese Centennial Goals) onwards, cervical cancer could be eliminated by the late 2040s (namely, ahead of the second Chinese Centennial Goals) while saving net economic costs in China.

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Economic evaluation of cervical cancer screening strategies in urban China

Cited by 9 publications

References 29 publications

Effectiveness of High-risk Human Papillomavirus Testing for Cervical Cancer Screening in China

Effectiveness of High-risk Human Papillomavirus Testing for Cervical Cancer Screening in China

Global trends and age-specific incidence and mortality of cervical cancer from 1990 to 2019: an international comparative study based on the Global Burden of Disease

Effectiveness and cost-effectiveness of eliminating cervical cancer through a tailored optimal pathway: a modeling study

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