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首页> 美国卫生研究院文献>Wiley-Blackwell Online Open >To expand coverage or increase frequency: Quantifying the tradeoffs between equity and efficiency facing cervical cancer screening programs in low‐resource settings
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To expand coverage or increase frequency: Quantifying the tradeoffs between equity and efficiency facing cervical cancer screening programs in low‐resource settings

机译：要扩大覆盖范围或增加频率：量化在资源贫乏地区子宫颈癌筛查计划所面临的公平与效率之间的权衡

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Cervical cancer is a leading cause of cancer death worldwide, with 85% of the disease burden residing in less developed regions. To inform evidence‐based decision‐making as cervical cancer screening programs are planned, implemented, and scaled in low‐ and middle‐income countries, we used cost and test performance data from the START‐UP demonstration project in Uganda and a microsimulation model of HPV infection and cervical carcinogenesis to quantify the health benefits, distributional equity, cost‐effectiveness, and financial impact of either (1) improving access to cervical cancer screening or (2) increasing the number of lifetime screening opportunities for women who already have access. We found that when baseline screening coverage was low (i.e., 30%), expanding coverage of screening once in a lifetime to 50% can yield comparable reductions in cancer risk to screening two or three times in a lifetime at 30% coverage, lead to greater reductions in health disparities, and cost 150 international dollars (I$) per year of life saved (YLS). At higher baseline screening coverage levels (i.e., 70%), screening three times in a lifetime yielded greater health benefits than expanding screening once in a lifetime to 90% coverage, and would have a cost‐effectiveness ratio (I$590 per YLS) below Uganda's per capita GDP. Given very low baseline coverage at present, we conclude that a policy focus on increasing access for previously unscreened women appears to be more compatible with improving both equity and efficiency than a focus on increasing frequency for a small subset of women.
机译：宫颈癌是全世界癌症死亡的主要原因，其中85％的疾病负担位于欠发达地区。为了在中低收入国家计划，实施和扩展宫颈癌筛查计划时为基于证据的决策提供信息，我们使用了乌干达START-UP示范项目的成本和测试绩效数据以及一个微观模拟模型。 HPV感染和子宫颈癌的发生，以量化以下方面的健康益处，分配公平性，成本效益和财务影响：（1）改善子宫颈癌筛查的机会，或（2）增加已经有生命的妇女的终生筛查机会的数量。我们发现，当基线筛查覆盖率较低（即30％）时，将一生一次筛查的覆盖率扩大到50％可以产生与一生中以30％覆盖率进行一两次筛查的癌症风险相当的降低，从而导致更大程度地减少卫生差距，每年每挽救生命（YLS）花费150国际美元。在较高的基线筛查覆盖率水平（即70％）下，一生中进行三次筛查比一生中一次筛查扩大到90％覆盖率具有更大的健康益处，并且成本效益比（每YLS 590 I $）低于乌干达的人均国内生产总值。鉴于目前的基线覆盖率很低，我们得出结论，与侧重于增加一小部分妇女的频率相比，侧重于增加以前未经筛查的妇女获得服务的政策似乎与提高公平性和效率更加兼容。

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