1
|
Xu X, Ping P, Zhang Z, Zou L. Plasma free fatty acid levels in cervical cancer: concurrent chemoradiotherapy improves abnormal profile. Front Pharmacol 2024; 15:1352101. [PMID: 38449803 PMCID: PMC10916716 DOI: 10.3389/fphar.2024.1352101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/09/2024] [Indexed: 03/08/2024] Open
Abstract
Background: Epidemiology has demonstrated that plasma free fatty acids (FFAs) can prevent the development of cancer. Our study sought to evaluate the relationship between plasma (FFA) levels and cervical cancer. Methods: In recent years, metabolomics-based approaches have been recognized as an emerging tool, so we examined the plasma FFA profiles of 114 patients with cervical cancer and 151 healthy people using liquid chromatography-tandem mass spectrometry (LC-MS/MS) methods. Results: The data results were analyzed by multifactorial binary logistic regression analysis, and it was found that palmitic acid, docosahexaenoic acid (DHA), and total ω-3 fatty acids were negatively correlated with the risk of cervical cancer; whereas tetracosanoic acid was positively correlated with the risk of cervical cancer (OR, 1.026; 95% CI, 1.013-1.040; p < 0.001). Dynamic follow-up of 40 cervical cancer patients who successfully completed CCRT revealed that most fatty acid levels tended to increase after the end of treatment, except for palmitic and stearic acid levels, which were lower than before treatment. Conclusion: Plasma FFA profiles were altered in cervical cancer patients, which may be related to abnormal fatty acid metabolism in cervical cancer. The described changes in fatty acid profiles during CCRT may be related to the good functioning of CCRT. Further studies on plasma FFA composition and its changes due to CCRT in patients with cervical cancer are warranted.
Collapse
Affiliation(s)
| | | | - Zhuo Zhang
- Department of Radiotherapy Oncology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lijuan Zou
- Department of Radiotherapy Oncology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| |
Collapse
|
2
|
Simms KT, Keane A, Nguyen DTN, Caruana M, Hall MT, Lui G, Gauvreau C, Demke O, Arbyn M, Basu P, Wentzensen N, Lauby-Secretan B, Ilbawi A, Hutubessy R, Almonte M, De Sanjosé S, Kelly H, Dalal S, Eckert LO, Santesso N, Broutet N, Canfell K. Benefits, harms and cost-effectiveness of cervical screening, triage and treatment strategies for women in the general population. Nat Med 2023; 29:3050-3058. [PMID: 38087115 PMCID: PMC10719104 DOI: 10.1038/s41591-023-02600-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 09/19/2023] [Indexed: 12/17/2023]
Abstract
In 2020, the World Health Organization (WHO) launched a strategy to eliminate cervical cancer as a public health problem. To support the strategy, the WHO published updated cervical screening guidelines in 2021. To inform this update, we used an established modeling platform, Policy1-Cervix, to evaluate the impact of seven primary screening scenarios across 78 low- and lower-middle-income countries (LMICs) for the general population of women. Assuming 70% coverage, we found that primary human papillomavirus (HPV) screening approaches were the most effective and cost-effective, reducing cervical cancer age-standardized mortality rates by 63-67% when offered every 5 years. Strategies involving triaging women before treatment (with 16/18 genotyping, cytology, visual inspection with acetic acid (VIA) or colposcopy) had close-to-similar effectiveness to HPV screening without triage and fewer pre-cancer treatments. Screening with VIA or cytology every 3 years was less effective and less cost-effective than HPV screening every 5 years. Furthermore, VIA generated more than double the number of pre-cancer treatments compared to HPV. In conclusion, primary HPV screening is the most effective, cost-effective and efficient cervical screening option in LMICs. These findings have directly informed WHO's updated cervical screening guidelines for the general population of women, which recommend primary HPV screening in a screen-and-treat or screen-triage-and-treat approach, starting from age 30 years with screening every 5 years or 10 years.
Collapse
Affiliation(s)
- Kate T Simms
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia.
| | - Adam Keane
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Diep Thi Ngoc Nguyen
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Michael Caruana
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Michaela T Hall
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Gigi Lui
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Cindy Gauvreau
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- SUCCESS Project, Expertise France, Paris, France
| | - Owen Demke
- Global Diagnostics, Clinton Health Access Initiative, Kigali, Rwanda
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
| | - Partha Basu
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Beatrice Lauby-Secretan
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer (IARC), Lyon, France
| | - Andre Ilbawi
- Department for the Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Maribel Almonte
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
| | - Silvia De Sanjosé
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
- ISGlobal, Barcelona, Spain
| | - Helen Kelly
- London School of Hygiene & Tropical Medicine, London, UK
| | - Shona Dalal
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Linda O Eckert
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Nancy Santesso
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Nathalie Broutet
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Karen Canfell
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| |
Collapse
|
3
|
Narasimhamurthy M, Kafle SU. Cervical cancer in Nepal: Current screening strategies and challenges. Front Public Health 2022; 10:980899. [PMID: 36466479 PMCID: PMC9713638 DOI: 10.3389/fpubh.2022.980899] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/24/2022] [Indexed: 11/18/2022] Open
Abstract
Nepal has a high burden of cervical cancer primarily due to a limited screening program. Most present with advanced cervical disease. Despite no national cervical cancer control program, Nepal's Ministry of Health and Population has taken many initiatives with various international collaborations in screening, vaccination, and treating pre-invasive and invasive cancer. However, the existing prevention and treatment modalities are dismally inadequate to meet the targets of WHO's cervical cancer eliminative initiative by 2030. We provide an overview of the Ministry of Health and Population, Nepal's efforts to tackle the growing cervical cancer burden in the country. We discuss the challenges and potential solutions that could be practical and augment screening uptakes, such as single-dose vaccination and HPV DNA tests. The screen-and-treat approach on the same day could potentially address treatment delays and follow-up loss after testing positive. Our narrative summary highlights existing and innovative strategies, unmet needs, and collaborations required to achieve elimination across implementation contexts.
Collapse
Affiliation(s)
- Mohan Narasimhamurthy
- Department of Pathology and Laboratory Medicine, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, PA, United States,*Correspondence: Mohan Narasimhamurthy
| | | |
Collapse
|
4
|
Sefuthi T, Nkonki L. A systematic review of economic evaluations of cervical cancer screening methods. Syst Rev 2022; 11:162. [PMID: 35945642 PMCID: PMC9361672 DOI: 10.1186/s13643-022-02017-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The aims of this systematic review were to (1) identify primary- and model-based economic evaluations of cervical cancer screening methods and to (2) provide a contextual summary of valuation outcomes associated with three types of cervical cancer screening tests: visual inspection with acetic acid, human papillomavirus deoxyribonucleic acid, and Papanicolaou smear. INTRODUCTION Cervical cancer screening is an important public health priority with the potential to improve the detection of precancerous lesions in high-risk females for early intervention and disease prevention. Test performance and cost-effectiveness differ based on the specific screening method used across different platforms. There is a need to appraise existing economic evaluations of cervical cancer screening methods. METHODS This review considered primary-based and model-based full economic evaluations of cervical cancer screening methods. The evaluation methods of interest included cost-effectiveness analysis, cost-utility analysis, cost-minimization analysis, cost-benefit analysis, and cost-consequence analysis. We searched Scopus, PubMed, National Health Economic Evaluation Database (NH EED), Cochrane, and the Health Economic Evaluation Database for full economic evaluations of cancer screening methods. No formal date restrictions were applied. Model-based and primary-based full economic evaluations were included. A critical appraisal of included studies was performed by the main investigator, while a second independent reviewer assessed critical appraisal findings for any inconsistencies. Data were extracted using a standardised data extraction tool for economic evaluations. The ultimate outcomes of costs, effectiveness, benefits, and utilities of cervical cancer screening modalities were extracted from included studies, analysed, and summarised. RESULTS From a total of 671 screened studies, 44 studies met the study inclusion criteria. Forty-three studies were cost-effectiveness analyses, one study reported both cost-utility and cost-effectiveness outcomes, and another study reported cost utilities of cervical cancer screening methods only. Human papillomavirus (HPV) DNA testing was reported as a dominant stand-alone screening test by 14 studies, while five studies reported visual inspection with acetic acid (VIA) as a dominant stand-alone screening test. Primary HPV screening strategies were dominant in 21 studies, while three studies reported cytology-based screening strategies as the dominant screening method. CONCLUSIONS Existing evidence indicates that HPV-based and VIA testing strategies are cost-effective, but this is dependent on setting. Our review suggests the limited cost-effectiveness of cytology-based testing, which may be due in part to the need for specific infrastructures and human resources. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020212454 .
Collapse
Affiliation(s)
- Thatohatsi Sefuthi
- Division of Health Systems and Public Health, Global Health Department, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
| | - Lungiswa Nkonki
- Health Economics, Division of Health Systems and Public Health, Global Health Department, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| |
Collapse
|
5
|
Shin MB, Garcia PJ, Saldarriaga EM, Fiestas JL, Ásbjörnsdóttir KH, Iribarren SJ, Barnabas RV, Gimbel S. Cost of community-based human papillomavirus self-sampling in Peru: A micro-costing study. LANCET REGIONAL HEALTH. AMERICAS 2022; 8:100160. [PMID: 35528707 PMCID: PMC9075528 DOI: 10.1016/j.lana.2021.100160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background Cost data of human papillomavirus (HPV) self-sampling programs from low-and-middle-income countries is limited. We estimated the total and unit costs associated with the Hope Project, a community-based HPV self-sampling social entrepreneurship in Peru. Methods We conducted a micro-costing analysis from the program perspective to determine the unit costs of (1) recruitment/training of community women (Hope Ladies); (2) Hope Ladies distributing HPV self-sampling kits in their communities and the laboratory testing; and (3) Hope Ladies linking screened women with follow-up care. A procedural manual was used to identify the program's activities. A structured questionnaire and in-depth interviews were conducted with administrators to estimate the resource/time associated with activities. We obtained unit costs for each input previously identified from budgets and expenditure reports. Findings From November 2018 to March 2020, the program recruited and trained 62 Hope Ladies who distributed 4,882 HPV self-sampling kits in their communities. Of the screened women, 586 (12%) tested HPV positive. The annual cost per Hope Lady recruited/trained was $147·51 (2018 USD). The cost per HPV self-sampling kit distributed/tested was $45·39, the cost per woman followed up with results was $55·64, and the cost per HPV-positive woman identified was $378·14. Personnel and laboratory costs represented 56·1% and 24·7% of the total programmatic cost, respectively. Interpretation Our findings indicate that implementation of a community-based HPV self-sampling has competitive prices, which increases its likelihood to be feasible in Peru. Further economic evaluation is needed to quantify the incremental benefits of HPV self-sampling compared to more established options such as Pap tests. Funding Thomas Francis Jr. Fellowship provided funding for data collection. The Hope Project was funded by grants from Grand Challenges Canada (TTS-1812-21131), Uniting for Health Innovation, Global Initiative Against HPV and Cervical Cancer, University of Manitoba, and the John E. Fogarty International Center (5D43TW009375-05).
Collapse
Affiliation(s)
- Michelle B. Shin
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Patricia J. Garcia
- School of Public Health, Cayetano Heredia University, Lima, Peru
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Enrique M. Saldarriaga
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, United States
| | - José L. Fiestas
- School of Public Health, Cayetano Heredia University, Lima, Peru
| | - Kristjana H Ásbjörnsdóttir
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Sarah J. Iribarren
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, United States
| | - Ruanne V. Barnabas
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Medicine, University of Washington, Seattle, WA, United States
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Sarah Gimbel
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA, United States
| |
Collapse
|
6
|
Nguyen DTN, Simms KT, Keane A, Mola G, Bolnga JW, Kuk J, Toliman PJ, Badman SG, Saville M, Kaldor J, Vallely A, Canfell K. Towards the elimination of cervical cancer in low-income and lower-middle-income countries: modelled evaluation of the effectiveness and cost-effectiveness of point-of-care HPV self-collected screening and treatment in Papua New Guinea. BMJ Glob Health 2022; 7:bmjgh-2021-007380. [PMID: 35241461 PMCID: PMC8896000 DOI: 10.1136/bmjgh-2021-007380] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/23/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction WHO has launched updated cervical screening guidelines, including provisions for primary HPV screen-and-treat. Papua New Guinea (PNG) has a high burden of cervical cancer, but no national cervical screening programme. We recently completed the first field trials of a screen-and-treat algorithm using point-of-care self-collected HPV and same-day treatment (hereafter self-collected HPV S&T) and showed this had superior clinical performance and acceptability to visual inspection of the cervix with acetic acid (VIA). We, therefore, evaluated the effectiveness, cost-effectiveness and resource implications of a national cervical screening programme using self-collected HPV S&T compared with VIA in PNG. Methods An extensively validated platform (‘Policy1-Cervix’) was calibrated to PNG. A total of 38 strategies were selected for investigation, and these incorporated variations in age ranges and screening frequencies and allowed for the identification of the optimal strategy across a wide range of possibilities. A selection of strategies that were identified as being the most effective and cost-effective were then selected for further investigation for longer-term outcomes and budget impact estimation. In the base case, we assumed primary HPV testing has a sensitivity to cervical intraepithelial neoplasia 2 (CIN2+) + of 91.8% and primary VIA of 51.5% based on our earlier field evaluation combined with evidence from the literature. We conservatively assumed HPV sampling and testing would cost US$18. Costs were estimated from a service provider perspective based on data from local field trials and local consultation. Results Self-collected HPV S&T was more effective and more cost-effective than VIA. Either twice or thrice lifetime self-collected HPV S&T would be cost-effective at 0.5× gross domestic product (GDP) per capita (incremental cost-effectiveness ratio: US$460–US$656/life-years saved; 1GDPper-capita: US$2829 or PGK9446 (year 2019)) and could prevent 33 000–42 000 cases and 23 000–29 000 deaths in PNG over the next 50 years, if scale-up reached 70% coverage from 2023. Conclusion Self-collected HPV S&T was effective and cost-effective in the high-burden, low-resource setting of PNG, and, if scaled-up rapidly, could prevent over 20 000 deaths over the next 50 years. VIA screening was not effective or cost-effective. These findings support, at a country level, WHO updated cervical screening guidelines and indicate that similar approaches could be appropriate for other low-resource settings.
Collapse
Affiliation(s)
| | - Kate T Simms
- Daffodil Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Adam Keane
- Daffodil Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Glen Mola
- Department of Reproductive Health, Obstetrics and Gynecology, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, CND, Papua New Guinea.,Department of Obstetrics and Gynecology, Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - John Walpe Bolnga
- Department of Obstetrics and Gynecology, Modilion Hospital, Mango, Madang, Papua New Guinea
| | - Joseph Kuk
- Department of Obstetrics and Gynecology, Mt Hagen Provincial Hospital, Mt Hagen, Western Highlands Province, Papua New Guinea
| | - Pamela J Toliman
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Steven G Badman
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Marion Saville
- Australian Centre for the Prevention of Cervical Cancer, Melbourne, Victoria, Australia
| | - John Kaldor
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Vallely
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Karen Canfell
- Daffodil Centre, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
7
|
Pedersen K, Portnoy A, Sy S, Hansen BT, Tropé A, Kim JJ, Burger EA. Switching clinic-based cervical cancer screening programs to human papillomavirus self-sampling: A cost-effectiveness analysis of vaccinated and unvaccinated Norwegian women. Int J Cancer 2022; 150:491-501. [PMID: 34664271 DOI: 10.1002/ijc.33850] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 08/30/2021] [Accepted: 09/28/2021] [Indexed: 11/07/2022]
Abstract
Several countries have implemented primary human papillomavirus (HPV) testing for cervical cancer screening. HPV testing enables home-based, self-collected sampling (self-sampling), which provides similar diagnostic accuracy as clinician-collected samples. We evaluated the impact and cost-effectiveness of switching an entire organized screening program to primary HPV self-sampling among cohorts of HPV vaccinated and unvaccinated Norwegian women. We conducted a model-based analysis to project long-term health and economic outcomes for birth cohorts with different HPV vaccine exposure, that is, preadolescent vaccination (2000- and 2008-cohorts), multiage cohort vaccination (1991-cohort) or no vaccination (1985-cohort). We compared the cost-effectiveness of switching current guidelines with clinician-collected HPV testing to HPV self-sampling for these cohorts and considered an additional 44 strategies involving either HPV self-sampling or clinician-collected HPV testing at different screening frequencies for the 2000- and 2008-cohorts. Given Norwegian benchmarks for cost-effectiveness, we considered a strategy with an additional cost per quality-adjusted life-year below $55 000 as cost-effective. HPV self-sampling strategies considerably reduced screening costs (ie, by 24%-40% across cohorts and alternative strategies) and were more cost-effective than clinician-collected HPV testing. For cohorts offered preadolescent vaccination, cost-effective strategies involved HPV self-sampling three times (2000-cohort) and twice (2008-cohort) per lifetime. In conclusion, we found that switching from clinician-collected to self-collected HPV testing in cervical screening may be cost-effective among both highly vaccinated and unvaccinated cohorts of Norwegian women.
Collapse
Affiliation(s)
- Kine Pedersen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Allison Portnoy
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Stephen Sy
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | | | - Jane J Kim
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Emily A Burger
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
8
|
Cromwell I, Smith LW, van der Hoek K, Hedden L, Coldman AJ, Cook D, Franco EL, Krajden M, Martin R, Lee MH, Stuart G, van Niekerk D, Ogilvie G, Peacock S. Cost-effectiveness analysis of primary human papillomavirus testing in cervical cancer screening: Results from the HPV FOCAL Trial. Cancer Med 2021; 10:2996-3003. [PMID: 33811457 PMCID: PMC8085916 DOI: 10.1002/cam4.3864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/11/2021] [Accepted: 02/25/2021] [Indexed: 12/31/2022] Open
Abstract
The Human Papillomavirus FOr CervicAL cancer (HPV FOCAL) trial is a large randomized controlled trial comparing the efficacy of primary HPV testing to cytology among women in the population-based Cervix Screening Program in British Columbia, Canada. We conducted a cost-effectiveness analysis based on the HPV FOCAL trial to estimate the incremental cost per detected high-grade cervical intraepithelial neoplasia of grade 2 or worse lesions (CIN2+). A total of 19,009 women aged 25 to 65 were randomized to one of two study groups. Women in the intervention group received primary HPV testing with reflex liquid-based cytology (LBC) upon a positive finding with a screening interval of 48 months. Women in the control group received primary LBC testing, and those negative returned at 24 months for LBC and again at 48 months for exit screening. Both groups received HPV and LBC co-testing at the 48-month exit. Incremental costs during the course of the trial were comparable between the intervention and control groups. The intervention group had lower overall costs and detected a larger number of CIN2+ lesions, resulting in a lower mean cost per CIN2+ detected ($7551) than the control group ($8325), a difference of -$773 [all costs in 2018 USD]. Cost per detected lesion was sensitive to the costs of sample collection, HPV testing, and LBC testing. The HPV FOCAL Trial results suggest that primary HPV testing every 4 years produces similar outcomes to LBC-based testing every 2 years for cervical cancer screening at a lower cost.
Collapse
Affiliation(s)
- Ian Cromwell
- Canadian Centre for Applied Research in Cancer ControlBC Cancer Research InstituteVancouverBCCanada
- British Columbia Cancer AgencyCancer Control ResearchBC Cancer Research InstituteVancouverBCCanada
- Canadian Agency for Drugs and Technologies in HealthOttawaONCanada
| | - Laurie W. Smith
- British Columbia Cancer AgencyCancer Control ResearchBC Cancer Research InstituteVancouverBCCanada
| | - Kim van der Hoek
- Canadian Centre for Applied Research in Cancer ControlBC Cancer Research InstituteVancouverBCCanada
- British Columbia Cancer AgencyCancer Control ResearchBC Cancer Research InstituteVancouverBCCanada
| | - Lindsay Hedden
- Faculty of Health SciencesSimon Fraser UniversityBurnabyBCCanada
- BC Academic Health Sciences NetworkVancouverBCCanada
| | - Andrew J. Coldman
- British Columbia Cancer AgencyCancer Control ResearchBC Cancer Research InstituteVancouverBCCanada
| | - Darrel Cook
- British Columbia Centre for Disease ControlVancouverBCCanada
| | | | - Mel Krajden
- British Columbia Centre for Disease ControlVancouverBCCanada
| | - Ruth Martin
- British Columbia Cancer AgencyCervical Cancer Screening ProgramVancouverBCCanada
| | - Marette H. Lee
- British Columbia Cancer AgencyCervical Cancer Screening ProgramVancouverBCCanada
- Vancouver General HospitalGynecologic OncologyVancouverBCCanada
| | - Gavin Stuart
- Faculty of MedicineThe University of British ColumbiaVancouverBCCanada
| | - Dirk van Niekerk
- British Columbia Cancer AgencyCervical Cancer Screening ProgramVancouverBCCanada
| | - Gina Ogilvie
- British Columbia Centre for Disease ControlVancouverBCCanada
- Faculty of MedicineThe University of British ColumbiaVancouverBCCanada
- Women’s Health Research InstituteBC Women’s HospitalVancouverBCCanada
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer ControlBC Cancer Research InstituteVancouverBCCanada
- British Columbia Cancer AgencyCancer Control ResearchBC Cancer Research InstituteVancouverBCCanada
- Faculty of Health SciencesSimon Fraser UniversityBurnabyBCCanada
| |
Collapse
|
9
|
Health economic evaluation of primary human papillomavirus screening in urban populations in China. Cancer Epidemiol 2020; 70:101861. [PMID: 33310688 DOI: 10.1016/j.canep.2020.101861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/02/2020] [Accepted: 11/15/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND On Nov 17, 2020, WHO launched a global initiative to accelerate the elimination of cervical cancer through the implementation of HPV vaccination, cervical cancer screening and treatment for precancer and cancer. China has the largest burden of cervical cancer in the world, but only has a national cervical cancer screening program in rural areas since 2009. Here, we aimed to evaluate the effectiveness and cost-effectiveness of cervical cancer screening in urban China, using Shenzhen City as an example. METHODS We use an extensively validated platform ('Policy1-Cervix'), calibrated to data from Shenzhen city and Guandong Province. We evaluated a range of strategies that have previously been implemented as pilot studies in China, or recommended as guidelines within China and globally, spanning primary HPV, cytology and co-testing strategies. We additionally considered alternate triaging methods, age ranges and screening intervals, resulting in 19 algorithms in total. RESULTS Of the 19 strategies considered, the most effective approach involved primary HPV testing. At 3- to 10-yearly intervals, primary HPV testing reduced the age-standardized cancer mortality rate by 37-71 %. The most cost-effective strategy was 5-yearly primary HPV testing with partial genotyping triage for ages 25-65, discharging to 10-yearly screening for low-risk women (ICER = US$7191/QALYS using 2018 costs; willingness-to-pay threshold<1xGDP [US$9771]). This strategy gave an incidence and mortality reduction of 56 % and 63 %, respectively. This remained the most cost-effective strategy under most conditions in sensitivity analysis. CONCLUSION Primary HPV testing would be cost-effective in Shenzhen and could more than halve cervical cancer incidence rates to 6 per 100,000 over the long term. In order to achieve rates below 4 per 100,000, the elimination threshold set by the World Health Organization, vaccination will likely also be necessary.
Collapse
|
10
|
Zhao F, Wen Y, Li Y, Tao S, Ma L, Zhao Y, Dang L, Wang Y, Zhao F, Lang J, Qiao Y, Yang CX. Epidemiologic and Health Economic Evaluation of Cervical Cancer Screening in Rural China. Asian Pac J Cancer Prev 2020; 21:1317-1325. [PMID: 32458639 PMCID: PMC7541874 DOI: 10.31557/apjcp.2020.21.5.1317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Cervical cancer is preventable and curable by detected early and managed effectively. To explore the most economical and effective cervical cancer screening strategies would lay a solid foundation for reducing the health and economic burden of cervical cancer. METHODS A Markov model was established for a cohort of 100,000 female to simulate the natural history of cervical cancer. 18 screening strategies were estimated including careHPV, Thin prep cytologic (TCT), Visual inspection with acetic acid/ Lugol's iodine (VIA / VILI), careHPV in series with VIA / VILI, careHPV in series with TCT, three methods parallel connection every 1, 3, 5 years respectively. Model outcomes included cumulative risk of incidence and death of cervical cancer, quality-adjusted life years (QALYs), cost-effectiveness ratios (CERs), incremental cost-effectiveness ratios (ICERs), cost-utility ratios (CURs) and benefits. RESULTS According to the results of epidemiological analysis, careHPV similar to the parallel connection every 1 year achieved highest epidemiological effects via reducing the cumulative risk of onset and death by more than 98 %. In health-economic terms, CER among all the screening strategies ranged from -756.34 to 113040.3 Yuan per year and CUR ranged from -169.91 to 11968.27 Yuan per QALY. The benefit ranged from -1629 to 996 Yuan. The incremental cost-effectiveness analysis showed that three methods in parallel every 1 year, TCT every 1 year, VIA/VILI every 1, 3, 5 years and careHPV every 5 years were dominant strategies. CONCLUSION Considering the economic and health benefits of all the strategies, our results suggested careHPV every 3 or 5 years and VIA/VILI every 1 or 3 years eventually were more appropriate as screening methods in rural China.
Collapse
Affiliation(s)
- Fei Zhao
- West China School of Public Health and West Fourth Hospital, Sichuan University, Chengdu, China
| | - Ying Wen
- West China School of Public Health and West Fourth Hospital, Sichuan University, Chengdu, China.,Department of Molecular Epidemiology, Shenzhen Center for Disease Control and Prevention, Shenzhen,China
| | - Yang Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union M Medical College, Beijing, China
| | - Siyuan Tao
- West China School of Public Health and West Fourth Hospital, Sichuan University, Chengdu, China
| | - Li Ma
- Dalian Medical University, Dalian, China
| | - Yuqian Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Sichuan Cancer Hospital &Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science &Technology of China, Chengdu, China
| | - Le Dang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Wang
- West China School of Public Health and West Fourth Hospital, Sichuan University, Chengdu, China
| | - Fanghui Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinghe Lang
- Peking Union Medical college Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College(CAMS/PUMC), Beijing, China
| | - Youlin Qiao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chun-Xia Yang
- West China School of Public Health and West Fourth Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
11
|
Zheng S, Li R, Liang J, Wen Z, Huang X, Du X, Dong S, Zhu K, Chen X, Liu D, Wu J, Liu Y, Zou X, Wang Y, Li J, Zeng F, Feng L, Yang G, Jing C. Serum miR-638 Combined with Squamous Cell Carcinoma-Related Antigen as Potential Screening Biomarkers for Cervical Squamous Cell Carcinoma. Genet Test Mol Biomarkers 2020; 24:188-194. [DOI: 10.1089/gtmb.2019.0147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Shaoling Zheng
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Ruixin Li
- Department of Gynecologic Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jiayu Liang
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Zihao Wen
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Xiuxia Huang
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Xiuben Du
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Shirui Dong
- Department of Pathogen Biology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Kehui Zhu
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Xiaojing Chen
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Dandan Liu
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Jing Wu
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Yumei Liu
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Xiaoqian Zou
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Yao Wang
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Jing Li
- Department of Gynecologic Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Fangfang Zeng
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Liping Feng
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina
| | - Guang Yang
- Department of Pathogen Biology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
- Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou, Guangdong, China
| | - Chunxia Jing
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
- Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou, Guangdong, China
| |
Collapse
|
12
|
Bhatla N, Singhal S. Primary HPV screening for cervical cancer. Best Pract Res Clin Obstet Gynaecol 2020; 65:98-108. [PMID: 32291178 DOI: 10.1016/j.bpobgyn.2020.02.008] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/21/2020] [Accepted: 02/21/2020] [Indexed: 12/24/2022]
Abstract
Cytology-based cervical screening had unequivocal success in reducing the incidence and mortality of cervical cancer in the last century. The recognition of the role of human papillomavirus (HPV) as a necessary cause of cervical cancer led to the development of HPV testing. Gradually, there has been a shift from reflex HPV testing for mild cytological abnormalities, to co-testing with cytology and HPV, and lately to primary HPV screening, based on evidence from well-designed large randomized controlled trials and meta-analyses. Advantages of primary HPV screening include higher sensitivity to detect pre-neoplastic lesions, better re-assurance with a negative test, and safe prolongation of screening intervals. However, clinicians and policy makers must ensure the availability of clinically validated HPV assays and triage protocols of screen positive cases prior to implementation of primary HPV screening. This is likely to reduce potential harm from over-treatment as well as extra burden on the health care system.
Collapse
Affiliation(s)
- Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
| | - Seema Singhal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
| |
Collapse
|
13
|
Malone C, Barnabas RV, Buist DSM, Tiro JA, Winer RL. Cost-effectiveness studies of HPV self-sampling: A systematic review. Prev Med 2020; 132:105953. [PMID: 31911163 PMCID: PMC7219564 DOI: 10.1016/j.ypmed.2019.105953] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 12/06/2019] [Accepted: 12/16/2019] [Indexed: 02/06/2023]
Abstract
HPV self-sampling (HPV-SS) can increase cervical cancer screening participation by addressing barriers in high- and low- and middle-income settings. Successful implementation of HPV-SS programs will depend on understanding potential costs and health effects. Our objectives were to summarize the methods and results of published HPV-SS cost and cost-effectiveness studies, present implications of these results for HPV-SS program implementation, and identify knowledge gaps. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. One reviewer searched online databases for articles published through June 12, 2019, identified eligible studies, and extracted data; a second reviewer checked extracted data for accuracy. Eligible studies used an economic model to compare HPV-SS outreach strategies to standard-of-care tests. Of 16 eligible studies, 14 reported HPV-SS could be a cost-effective strategy. Studies differed in model type, HPV-SS delivery methods, triage strategies for positive results, and target populations. Most (9/16) modeled HPV-SS in European screening programs, 6/16 targeted women who were underscreened for cervical cancer, and 5/16 modeled HPV-SS in low- and middle-income countries. The most commonly identified driver of HPV-SS cost-effectiveness was the level of increase in cervical cancer screening attendance. Lower HPV-SS material and testing costs, higher sensitivity to detect cervical precancer, and longer duration of underscreening among HPV-SS users were also associated with increased cost-effectiveness. Future HPV-SS models in high-income settings should explore the effect of widespread vaccination and new triage strategies such as partial HPV genotyping. Knowledge gaps remain about the cost-effectiveness of HPV-SS in low- and middle-income settings.
Collapse
Affiliation(s)
- Colin Malone
- Department of Epidemiology, University of Washington, Box 359933, 325 9th Ave, Seattle, WA 98104, USA.
| | - Ruanne V Barnabas
- Department of Global Health, University of Washington, Box 359931, 325 9th Ave, Seattle, WA 98104, USA.
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute,1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Jasmin A Tiro
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
| | - Rachel L Winer
- Department of Epidemiology, University of Washington, Box 359933, 325 9th Ave, Seattle, WA 98104, USA; Kaiser Permanente Washington Health Research Institute,1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| |
Collapse
|
14
|
Liu YJ, Keane A, Simms KT, Lew JB, Shi JF, Mazariego C, Yuill S, Jeronimo J, Qiao YL, Canfell K. Development and application of a framework to estimate health care costs in China: The cervical cancer example. PLoS One 2019; 14:e0222760. [PMID: 31574103 PMCID: PMC6773209 DOI: 10.1371/journal.pone.0222760] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 09/07/2019] [Indexed: 11/25/2022] Open
Abstract
Objectives Information on healthcare costs in low-and-middle-income countries is limited. This study presents a framework to perform healthcare cost estimates for each province in China. Methods This study has two aims. Using cervical cancer as an example, the first aim is to use data (including micro-costing data) from one province to derive estimates for other provinces in China. This used provincial and national Chinese-language statistical reports and considered levels of service delivery, hospital-seeking behaviour, and the urban/rural population distribution. The second aim is to characterise the relationship between the reference costs estimated using the method mentioned above and two sets of cost estimates derived using simplified cost-scaling method with per capita Gross Domestic Product (GDP), and the Human Development Index (HDI). For simplified methods, regression modelling characterised the relationship between province-specific healthcare costs and macro-economic indicators, then we used the exponential fit to extrapolate costs. Results Using the reference method, the estimated costs were found to vary substantially by urban/rural regions and between provinces; the ratios of highest to lowest provincial costs were 3.5 for visual inspection with acetic acid (VIA), 4.4 for cold knife conisation (CKC) and 4.6 for stage II cancer treatment. The HDI-based scaling method generally resulted in a better fit to reference costs than the GDP method. Conclusions These reference costs for cervical cancer can inform cost-effectiveness evaluation of cervical screening and HPV vaccination in China. HDI-based methods for cost-scaling-based on social, as well as purely economic, factors-have potential to provide more accurate estimates.
Collapse
Affiliation(s)
- Yi-Jun Liu
- School of Public Health, Zunyi Medical University, Zunyi, China
- Cancer Research Division, Cancer Council New South Wales, Sydney, Australia
| | - Adam Keane
- Cancer Research Division, Cancer Council New South Wales, Sydney, Australia
| | - Kate T. Simms
- Cancer Research Division, Cancer Council New South Wales, Sydney, Australia
| | - Jie-Bin Lew
- Cancer Research Division, Cancer Council New South Wales, Sydney, Australia
| | - Ju-Fang Shi
- Department of Epidemiology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Carolyn Mazariego
- Cancer Research Division, Cancer Council New South Wales, Sydney, Australia
| | - Susan Yuill
- Cancer Research Division, Cancer Council New South Wales, Sydney, Australia
| | - Jose Jeronimo
- Global Coalition against Cervical Cancer, Arlington, Virginia, United States of America
| | - You-Lin Qiao
- Department of Epidemiology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Karen Canfell
- Cancer Research Division, Cancer Council New South Wales, Sydney, Australia
- School of Public Health, University of Sydney, Sydney, Australia
- Prince of Wales Clinical School, Faculty of Medicine, UNSW, Sydney, Australia
- * E-mail:
| |
Collapse
|
15
|
Seay JS, Kobetz E. Optimizing Cervical Cancer Screening and Triage in Low-Resource Settings. J Glob Oncol 2019; 4:1-2. [PMID: 30252572 PMCID: PMC6223538 DOI: 10.1200/jgo.18.00192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Julia S Seay
- Julia S. Seay and Erin Kobetz, University of Miami School of Medicine, Miami, FL
| | - Erin Kobetz
- Julia S. Seay and Erin Kobetz, University of Miami School of Medicine, Miami, FL
| |
Collapse
|
16
|
Pathways to a cancer-free future: A protocol for modelled evaluations to maximize the future impact of interventions on cervical cancer in Australia. Gynecol Oncol 2019; 152:465-471. [PMID: 30876490 DOI: 10.1016/j.ygyno.2018.12.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/05/2018] [Accepted: 12/21/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Australia's HPV vaccination and HPV-based cervical screening programs are changing the landscape in cervical cancer prevention. We aim to identify areas which can make the biggest further impact on cervical cancer burden. This protocol describes the first stage of a program of work called Pathways-Cervix that aims to generate evidence from modelled evaluations of interventions across the cervical cancer spectrum. METHODS Based on evidence from literature reviews and guidance from a multi-disciplinary Scientific Advisory Committee (SAC), the most relevant evaluations for prevention, diagnosis and treatment were identified. RESULTS Priority evaluations agreed by the SAC included: increasing/decreasing and retaining vaccination uptake at the current level; vaccinating older women; increasing screening participation; methods for triaging HPV-positive women; improving the diagnosis of cervical intraepithelial neoplasia (CIN) and cancer; treating cervical abnormalities and cancer; and vaccinating women treated for CIN2/3 to prevent recurrence. Evaluations will be performed using a simulation model, Policy1-Cervix previously used to perform policy evaluations in Australia. Exploratory modelling of interventions using idealised scenarios will initially be conducted in single birth cohorts. If these have a significant impact on findings then evaluations with more realistic assumptions will be conducted. Promising strategies will be investigated further by multi-cohort simulations predicting health outcomes, resource use and cost outcomes. CONCLUSIONS Pathways-Cervix will assess the relative benefits of strategies and treatment options in a systematic and health economic framework, producing a list of 'best buys' for future decision-making in cervical cancer control.
Collapse
|
17
|
Ma L, Wang Y, Gao X, Dai Y, Zhang Y, Wang Z, Wang X, Wang L, Jiang J, Jing X, Yang C, Zhao F, Lang J, Qiao Y. Economic evaluation of cervical cancer screening strategies in urban China. Chin J Cancer Res 2019; 31:974-983. [PMID: 31949399 PMCID: PMC6955165 DOI: 10.21147/j.issn.1000-9604.2019.06.13] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective This study evaluated the feasibility of different cervical cancer screening strategies in urban China. Methods A Markov model was constructed to simulate a hypothetical cohort of 100,000 females aged 30−59 years in a 20-year period. Screening strategies included liquid-based cytology (LBC) every three years, human papillomavirus (HPV) DNA testing every three and five years, respectively, and a combination of HPV DNA testing and LBC (HPV+LBC) every three and five years, respectively. Model outcomes included cumulative incidence over 20 years, cumulative risk of cervical cancer, costs, life year saved (LYS), quality-adjusted life years (QALYs) and benefits. The cost-effectiveness ratios (CERs), incremental cost-effectiveness ratios (ICERs), cost-utility ratios (CURs), and benefit-cost ratios (BCRs) were used as outcomes in the health economic evaluation analysis. Univariate sensitivity analyses were performed to examine the stability of the results. Results The cumulative incidence of the five screening strategies ranged from 833.02 to 1,158.07 cases per 100,000 females. HPV DNA testing was most effective in reducing the cumulative risk of cervical cancer, saving life years and QALYs and gaining benefits. The CERs of HPV DNA testing every three and five years, and LBC every three years were considered to be very cost-effective if they were below China’s GDP per capita. The CERs of HPV+LBC were considered to be cost-effective if they were below three times GDP per capita. The incremental cost-effectiveness analysis showed that HPV DNA testing every three and five years, LBC every three years and HPV+LBC every five years were dominant strategies. Conclusions The findings of this study indicated that HPV DNA testing every five years or LBC every three years should be recommended in urban China.
Collapse
Affiliation(s)
- Li Ma
- Department of Epidemiology, School of Public Health, Dalian Medical University, Dalian 116044, China
| | - Yuying Wang
- Department of Epidemiology, School of Public Health, Dalian Medical University, Dalian 116044, China
| | - Xiaohong Gao
- Department of Epidemiology, School of Public Health, Dalian Medical University, Dalian 116044, China
| | - Yi Dai
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100730, China
| | - Yu Zhang
- Department of Epidemiology, School of Public Health, Dalian Medical University, Dalian 116044, China
| | - Zhaojing Wang
- Department of Epidemiology, School of Public Health, Dalian Medical University, Dalian 116044, China
| | - Xiaoxia Wang
- Department of Obstetrics and Gynecology, Wafangdian Maternal and Child Health Care Hospital, Dalian 116300, China
| | - Limin Wang
- Department of Obstetrics and Gynecology, Wafangdian Maternal and Child Health Care Hospital, Dalian 116300, China
| | - Jing Jiang
- Department of Obstetrics and Gynecology, Wafangdian Maternal and Child Health Care Hospital, Dalian 116300, China
| | - Xinhua Jing
- Department of Obstetrics and Gynecology, Wafangdian Maternal and Child Health Care Hospital, Dalian 116300, China
| | - Chunxia Yang
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu 610041, China
| | - Fanghui Zhao
- Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jinghe Lang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100730, China
| | - Youlin Qiao
- Department of Epidemiology, School of Public Health, Dalian Medical University, Dalian 116044, China.,Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| |
Collapse
|
18
|
Viscondi JYK, Faustino CG, Campolina AG, Itria A, de Soárez PC. Simple but not simpler: a systematic review of Markov models for economic evaluation of cervical cancer screening. Clinics (Sao Paulo) 2018; 73:e385. [PMID: 29995100 PMCID: PMC6024522 DOI: 10.6061/clinics/2018/e385] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 02/26/2018] [Indexed: 12/21/2022] Open
Abstract
The aim of this study was to critically evaluate the quality of the models used in economic evaluations of screening strategies for cervical cancer prevention. We systematically searched multiple databases, selecting model-based full economic evaluations (cost-effectiveness analyses, cost-utility analyses, and cost-benefit analyses) of cervical cancer screening strategies. Two independent reviewers screened articles for relevance and performed data extraction. Methodological assessment of the quality of the models utilized formal checklists, and a qualitative narrative synthesis was performed. Thirty-eight articles were reviewed. The majority of the studies were conducted in high-income countries (82%, n=31). The Pap test was the most used screening strategy investigated, which was present in 86% (n=33) of the studies. Half of the studies (n=19) used a previously published Markov model. The deterministic sensitivity analysis was performed in 92% (n=35) of the studies. The mean number of properly reported checklist items was 9 out of the maximum possible 18. Items that were better reported included the statement of decision problem, the description of the strategies/comparators, the statement of time horizon, and information regarding the disease states. Compliance with some items of the checklist was poor. The Markov models for economic evaluation of screening strategies for cervical cancer varied in quality. The following points require improvement: 1) assessment of methodological, structural, heterogeneity, and parameter uncertainties; 2) model type and cycle length justification; 3) methods to account for heterogeneity; and 4) report of consistency evaluation (through calibration and validation methods).
Collapse
Affiliation(s)
| | | | - Alessandro Gonçalves Campolina
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Alexander Itria
- Instituto de Patologia Tropical e Saude Publica, Departamento de Saude Coletiva, Nucleo de Economia e Avaliacoes da Saude, Instituto de Avaliacao de Tecnologia em Saude, Universidade Federal de Goias, Goias, GO, BR
| | - Patricia Coelho de Soárez
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| |
Collapse
|
19
|
Jeronimo J, Castle PE, Temin S, Denny L, Gupta V, Kim JJ, Luciani S, Murokora D, Ngoma T, Qiao Y, Quinn M, Sankaranarayanan R, Sasieni P, Schmeler KM, Shastri SS. Secondary Prevention of Cervical Cancer: ASCO Resource-Stratified Clinical Practice Guideline. J Glob Oncol 2017; 3:635-657. [PMID: 29094101 PMCID: PMC5646891 DOI: 10.1200/jgo.2016.006577] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To provide resource-stratified, evidence-based recommendations on the secondary prevention of cervical cancer globally. METHODS ASCO convened a multidisciplinary, multinational panel of oncology, primary care, epidemiology, health economic, cancer control, public health, and patient advocacy experts to produce recommendations reflecting four resource-tiered settings. A review of existing guidelines, a formal consensus-based process, and a modified ADAPTE process to adapt existing guidelines were conducted. Other experts participated in formal consensus. RESULTS Seven existing guidelines were identified and reviewed, and adapted recommendations form the evidence base. Four systematic reviews plus cost-effectiveness analyses provided indirect evidence to inform consensus, which resulted in ≥ 75% agreement. RECOMMENDATIONS Human papillomavirus (HPV) DNA testing is recommended in all resource settings; visual inspection with acetic acid may be used in basic settings. Recommended age ranges and frequencies by setting are as follows: maximal: ages 25 to 65, every 5 years; enhanced: ages 30 to 65, if two consecutive negative tests at 5-year intervals, then every 10 years; limited: ages 30 to 49, every 10 years; and basic: ages 30 to 49, one to three times per lifetime. For basic settings, visual assessment is recommended as triage; in other settings, genotyping and/or cytology are recommended. For basic settings, treatment is recommended if abnormal triage results are present; in other settings, colposcopy is recommended for abnormal triage results. For basic settings, treatment options are cryotherapy or loop electrosurgical excision procedure; for other settings, loop electrosurgical excision procedure (or ablation) is recommended. Twelve-month post-treatment follow-up is recommended in all settings. Women who are HIV positive should be screened with HPV testing after diagnosis and screened twice as many times per lifetime as the general population. Screening is recommended at 6 weeks postpartum in basic settings; in other settings, screening is recommended at 6 months. In basic settings without mass screening, infrastructure for HPV testing, diagnosis, and treatment should be developed.Additional information can be found at www.asco.org/rs-cervical-cancer-secondary-prev-guideline and www.asco.org/guidelineswiki.It is the view of of ASCO that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement, but not replace, local guidelines.
Collapse
Affiliation(s)
- Jose Jeronimo
- , PATH, Seattle, WA; , Global Coalition Against Cervical Cancer, Albert Einstein College of Medicine, Arlington; , American Society of Clinical Oncology, Alexandria, VA; , University of Cape Town, Cape Town, South Africa; , V Care; , Tata Memorial Center, Mumbai, India; , Harvard T.H. Chan School of Public Health, Boston, MA; , PanAmerican Health Organization, Washington, DC; , Uganda Women's Health Initiative, Kampala, Uganda; , International Network for Cancer Treatment and Research, Dar Es Salaam, Tanzania; , Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; , University of Melbourne, Melbourne, Victoria, Australia; , International Agency for Research on Cancer, Lyon, France; , Queen Mary, University of London, London, United Kingdom; and , The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Philip E Castle
- , PATH, Seattle, WA; , Global Coalition Against Cervical Cancer, Albert Einstein College of Medicine, Arlington; , American Society of Clinical Oncology, Alexandria, VA; , University of Cape Town, Cape Town, South Africa; , V Care; , Tata Memorial Center, Mumbai, India; , Harvard T.H. Chan School of Public Health, Boston, MA; , PanAmerican Health Organization, Washington, DC; , Uganda Women's Health Initiative, Kampala, Uganda; , International Network for Cancer Treatment and Research, Dar Es Salaam, Tanzania; , Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; , University of Melbourne, Melbourne, Victoria, Australia; , International Agency for Research on Cancer, Lyon, France; , Queen Mary, University of London, London, United Kingdom; and , The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sarah Temin
- , PATH, Seattle, WA; , Global Coalition Against Cervical Cancer, Albert Einstein College of Medicine, Arlington; , American Society of Clinical Oncology, Alexandria, VA; , University of Cape Town, Cape Town, South Africa; , V Care; , Tata Memorial Center, Mumbai, India; , Harvard T.H. Chan School of Public Health, Boston, MA; , PanAmerican Health Organization, Washington, DC; , Uganda Women's Health Initiative, Kampala, Uganda; , International Network for Cancer Treatment and Research, Dar Es Salaam, Tanzania; , Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; , University of Melbourne, Melbourne, Victoria, Australia; , International Agency for Research on Cancer, Lyon, France; , Queen Mary, University of London, London, United Kingdom; and , The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lynette Denny
- , PATH, Seattle, WA; , Global Coalition Against Cervical Cancer, Albert Einstein College of Medicine, Arlington; , American Society of Clinical Oncology, Alexandria, VA; , University of Cape Town, Cape Town, South Africa; , V Care; , Tata Memorial Center, Mumbai, India; , Harvard T.H. Chan School of Public Health, Boston, MA; , PanAmerican Health Organization, Washington, DC; , Uganda Women's Health Initiative, Kampala, Uganda; , International Network for Cancer Treatment and Research, Dar Es Salaam, Tanzania; , Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; , University of Melbourne, Melbourne, Victoria, Australia; , International Agency for Research on Cancer, Lyon, France; , Queen Mary, University of London, London, United Kingdom; and , The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vandana Gupta
- , PATH, Seattle, WA; , Global Coalition Against Cervical Cancer, Albert Einstein College of Medicine, Arlington; , American Society of Clinical Oncology, Alexandria, VA; , University of Cape Town, Cape Town, South Africa; , V Care; , Tata Memorial Center, Mumbai, India; , Harvard T.H. Chan School of Public Health, Boston, MA; , PanAmerican Health Organization, Washington, DC; , Uganda Women's Health Initiative, Kampala, Uganda; , International Network for Cancer Treatment and Research, Dar Es Salaam, Tanzania; , Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; , University of Melbourne, Melbourne, Victoria, Australia; , International Agency for Research on Cancer, Lyon, France; , Queen Mary, University of London, London, United Kingdom; and , The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jane J Kim
- , PATH, Seattle, WA; , Global Coalition Against Cervical Cancer, Albert Einstein College of Medicine, Arlington; , American Society of Clinical Oncology, Alexandria, VA; , University of Cape Town, Cape Town, South Africa; , V Care; , Tata Memorial Center, Mumbai, India; , Harvard T.H. Chan School of Public Health, Boston, MA; , PanAmerican Health Organization, Washington, DC; , Uganda Women's Health Initiative, Kampala, Uganda; , International Network for Cancer Treatment and Research, Dar Es Salaam, Tanzania; , Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; , University of Melbourne, Melbourne, Victoria, Australia; , International Agency for Research on Cancer, Lyon, France; , Queen Mary, University of London, London, United Kingdom; and , The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Silvana Luciani
- , PATH, Seattle, WA; , Global Coalition Against Cervical Cancer, Albert Einstein College of Medicine, Arlington; , American Society of Clinical Oncology, Alexandria, VA; , University of Cape Town, Cape Town, South Africa; , V Care; , Tata Memorial Center, Mumbai, India; , Harvard T.H. Chan School of Public Health, Boston, MA; , PanAmerican Health Organization, Washington, DC; , Uganda Women's Health Initiative, Kampala, Uganda; , International Network for Cancer Treatment and Research, Dar Es Salaam, Tanzania; , Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; , University of Melbourne, Melbourne, Victoria, Australia; , International Agency for Research on Cancer, Lyon, France; , Queen Mary, University of London, London, United Kingdom; and , The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Daniel Murokora
- , PATH, Seattle, WA; , Global Coalition Against Cervical Cancer, Albert Einstein College of Medicine, Arlington; , American Society of Clinical Oncology, Alexandria, VA; , University of Cape Town, Cape Town, South Africa; , V Care; , Tata Memorial Center, Mumbai, India; , Harvard T.H. Chan School of Public Health, Boston, MA; , PanAmerican Health Organization, Washington, DC; , Uganda Women's Health Initiative, Kampala, Uganda; , International Network for Cancer Treatment and Research, Dar Es Salaam, Tanzania; , Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; , University of Melbourne, Melbourne, Victoria, Australia; , International Agency for Research on Cancer, Lyon, France; , Queen Mary, University of London, London, United Kingdom; and , The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Twalib Ngoma
- , PATH, Seattle, WA; , Global Coalition Against Cervical Cancer, Albert Einstein College of Medicine, Arlington; , American Society of Clinical Oncology, Alexandria, VA; , University of Cape Town, Cape Town, South Africa; , V Care; , Tata Memorial Center, Mumbai, India; , Harvard T.H. Chan School of Public Health, Boston, MA; , PanAmerican Health Organization, Washington, DC; , Uganda Women's Health Initiative, Kampala, Uganda; , International Network for Cancer Treatment and Research, Dar Es Salaam, Tanzania; , Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; , University of Melbourne, Melbourne, Victoria, Australia; , International Agency for Research on Cancer, Lyon, France; , Queen Mary, University of London, London, United Kingdom; and , The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Youlin Qiao
- , PATH, Seattle, WA; , Global Coalition Against Cervical Cancer, Albert Einstein College of Medicine, Arlington; , American Society of Clinical Oncology, Alexandria, VA; , University of Cape Town, Cape Town, South Africa; , V Care; , Tata Memorial Center, Mumbai, India; , Harvard T.H. Chan School of Public Health, Boston, MA; , PanAmerican Health Organization, Washington, DC; , Uganda Women's Health Initiative, Kampala, Uganda; , International Network for Cancer Treatment and Research, Dar Es Salaam, Tanzania; , Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; , University of Melbourne, Melbourne, Victoria, Australia; , International Agency for Research on Cancer, Lyon, France; , Queen Mary, University of London, London, United Kingdom; and , The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael Quinn
- , PATH, Seattle, WA; , Global Coalition Against Cervical Cancer, Albert Einstein College of Medicine, Arlington; , American Society of Clinical Oncology, Alexandria, VA; , University of Cape Town, Cape Town, South Africa; , V Care; , Tata Memorial Center, Mumbai, India; , Harvard T.H. Chan School of Public Health, Boston, MA; , PanAmerican Health Organization, Washington, DC; , Uganda Women's Health Initiative, Kampala, Uganda; , International Network for Cancer Treatment and Research, Dar Es Salaam, Tanzania; , Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; , University of Melbourne, Melbourne, Victoria, Australia; , International Agency for Research on Cancer, Lyon, France; , Queen Mary, University of London, London, United Kingdom; and , The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rengaswamy Sankaranarayanan
- , PATH, Seattle, WA; , Global Coalition Against Cervical Cancer, Albert Einstein College of Medicine, Arlington; , American Society of Clinical Oncology, Alexandria, VA; , University of Cape Town, Cape Town, South Africa; , V Care; , Tata Memorial Center, Mumbai, India; , Harvard T.H. Chan School of Public Health, Boston, MA; , PanAmerican Health Organization, Washington, DC; , Uganda Women's Health Initiative, Kampala, Uganda; , International Network for Cancer Treatment and Research, Dar Es Salaam, Tanzania; , Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; , University of Melbourne, Melbourne, Victoria, Australia; , International Agency for Research on Cancer, Lyon, France; , Queen Mary, University of London, London, United Kingdom; and , The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Peter Sasieni
- , PATH, Seattle, WA; , Global Coalition Against Cervical Cancer, Albert Einstein College of Medicine, Arlington; , American Society of Clinical Oncology, Alexandria, VA; , University of Cape Town, Cape Town, South Africa; , V Care; , Tata Memorial Center, Mumbai, India; , Harvard T.H. Chan School of Public Health, Boston, MA; , PanAmerican Health Organization, Washington, DC; , Uganda Women's Health Initiative, Kampala, Uganda; , International Network for Cancer Treatment and Research, Dar Es Salaam, Tanzania; , Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; , University of Melbourne, Melbourne, Victoria, Australia; , International Agency for Research on Cancer, Lyon, France; , Queen Mary, University of London, London, United Kingdom; and , The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kathleen M Schmeler
- , PATH, Seattle, WA; , Global Coalition Against Cervical Cancer, Albert Einstein College of Medicine, Arlington; , American Society of Clinical Oncology, Alexandria, VA; , University of Cape Town, Cape Town, South Africa; , V Care; , Tata Memorial Center, Mumbai, India; , Harvard T.H. Chan School of Public Health, Boston, MA; , PanAmerican Health Organization, Washington, DC; , Uganda Women's Health Initiative, Kampala, Uganda; , International Network for Cancer Treatment and Research, Dar Es Salaam, Tanzania; , Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; , University of Melbourne, Melbourne, Victoria, Australia; , International Agency for Research on Cancer, Lyon, France; , Queen Mary, University of London, London, United Kingdom; and , The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Surendra S Shastri
- , PATH, Seattle, WA; , Global Coalition Against Cervical Cancer, Albert Einstein College of Medicine, Arlington; , American Society of Clinical Oncology, Alexandria, VA; , University of Cape Town, Cape Town, South Africa; , V Care; , Tata Memorial Center, Mumbai, India; , Harvard T.H. Chan School of Public Health, Boston, MA; , PanAmerican Health Organization, Washington, DC; , Uganda Women's Health Initiative, Kampala, Uganda; , International Network for Cancer Treatment and Research, Dar Es Salaam, Tanzania; , Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; , University of Melbourne, Melbourne, Victoria, Australia; , International Agency for Research on Cancer, Lyon, France; , Queen Mary, University of London, London, United Kingdom; and , The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
20
|
Awua AK, Wiredu EK, Afari EA, Tijani AS, Djanmah G, Adanu RMK. A tailored within-community specimen collection strategy increased uptake of cervical cancer screening in a cross-sectional study in Ghana. BMC Public Health 2017; 18:80. [PMID: 28764756 PMCID: PMC5540566 DOI: 10.1186/s12889-017-4631-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/26/2017] [Indexed: 11/26/2022] Open
Abstract
Background The implementation of cervical cancer screening strategies has reported different rates of success in different countries due to population specific factors that limit women’s participation. We report observations and the development of a community-based specimen collection strategy which resulted from interactions with women in the study communities, following an initial low response to a hospital based cervical cancer screening strategy. Method Women were recruited by a house survey and invited to report at a hospital either within a week or after a week for self and health-personnel specimen collections. However, due to the very low response and subsequent interactions with the women of the communities, another strategy was developed that required recruited women report at a central location within their respective communities for specimen collections at times that did not interfere with their daily routines. Results For specimen collection, of the 156 participants who opted to report after a week at the hospital, 60 (38.5%) reported. Of the 118 participants who opted to report within 1 week at the hospital, 55 (46.6%) reported. Of the 103 participants were invited to report at a specified location within the community, 98 (95.1%) reported. An overall response rate of 60.4% was attained. Almost 89.7% (226 of 253) of the women performed both self and health personnel sample collection. Conclusion The community-based strategy with self-specimen collection and HPV testing holds great potential for increasing women’s participation in cervical cancer screening in Ghana as compared to the hospital based strategy. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4631-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Adolf K Awua
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana. .,Cellular and Clinical Research Centre, Radiological and Medical Sciences Research Institute, GAEC, Accra, Ghana.
| | - Edwin K Wiredu
- University of Health and Allied Sciences, Ho, Ghana.,Department of Pathology, School of Biomedical and Allied Health Science, College of Health Sciences, University of Ghana, Korle-Bu, Accra, Ghana
| | - Edwin A Afari
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Ahmad S Tijani
- Akuse Government Hospital, Ghana Health Service, Akuse, Ghana
| | - Gabriel Djanmah
- Akuse Government Hospital, Ghana Health Service, Akuse, Ghana
| | - Richard M K Adanu
- Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| |
Collapse
|
21
|
Zimmermann MR, Vodicka E, Babigumira JB, Okech T, Mugo N, Sakr S, Garrison LP, Chung MH. Cost-effectiveness of cervical cancer screening and preventative cryotherapy at an HIV treatment clinic in Kenya. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2017; 15:13. [PMID: 28725164 PMCID: PMC5513032 DOI: 10.1186/s12962-017-0075-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/04/2017] [Indexed: 12/30/2022] Open
Abstract
Objective This study evaluated the potential cost-effectiveness of cervical cancer screening in HIV treatment clinics in Nairobi, Kenya. Methods A Markov model was used to project health outcomes and costs of cervical cancer screening and cryotherapy at an HIV clinic in Kenya using cryotherapy without screening, visual inspection with acetic acid (VIA), Papanicolaou smear (Pap), and testing for human papillomavirus (HPV). Direct and indirect medical and non-medical costs were examined from societal and clinic perspectives. Results Costs of cryotherapy, VIA, Pap, and HPV for women with CD4 200–500 cells/mL were $99, $196, $219, and $223 from a societal perspective and $19, $94, $124, and $113 from a clinic perspective, with 17.3, 17.1, 17.1, and 17.1 years of life expectancy, respectively. Women at higher CD4 counts (>500 cells/mL) given cryotherapy VIA, Pap, and HPV resulted in better life expectancies (19.9+ years) and lower cost (societal: $49, $99, $115, and $102; clinic: $13, $51, $71, and $56). VIA was less expensive than HPV unless HPV screening could be reduced to a single visit. Conclusions Preventative cryotherapy was the least expensive strategy and resulted in highest projected life expectancy, while VIA was most cost-effective unless HPV could be reduced to a single visit.
Collapse
Affiliation(s)
- Marita R Zimmermann
- Department of Pharmacy, University of Washington, 1959 NE Pacific St., HSB H-375, Box 357630, Seattle, WA 98195 USA
| | - Elisabeth Vodicka
- Department of Pharmacy, University of Washington, 1959 NE Pacific St., HSB H-375, Box 357630, Seattle, WA 98195 USA
| | - Joseph B Babigumira
- Department of Global Health, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA 98104 USA
| | - Timothy Okech
- Chandaria School of Business, United States International University-Africa, Nairobi, Kenya
| | - Nelly Mugo
- Department of Obstetrics and Gynecology, Kenyatta National Hospital, Nairobi, Kenya
| | - Samah Sakr
- Coptic Hospital, Coptic Hope Center, Nairobi, Kenya
| | - Louis P Garrison
- Department of Pharmacy, University of Washington, 1959 NE Pacific St., HSB H-375, Box 357630, Seattle, WA 98195 USA
| | - Michael H Chung
- Department of Global Health, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA 98104 USA.,Department of Medicine, University of Washington, Seattle, WA USA.,Department of Epidemiology, University of Washington, Seattle, WA USA
| |
Collapse
|
22
|
Cost-effectiveness of cervical cancer screening methods in low- and middle-income countries: A systematic review. Int J Cancer 2017; 141:437-446. [DOI: 10.1002/ijc.30695] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/06/2017] [Accepted: 02/08/2017] [Indexed: 01/15/2023]
|
23
|
Hellner K, Dorrell L. Recent advances in understanding and preventing human papillomavirus-related disease. F1000Res 2017; 6:F1000 Faculty Rev-269. [PMID: 28357043 PMCID: PMC5357030 DOI: 10.12688/f1000research.9701.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2017] [Indexed: 12/19/2022] Open
Abstract
High-risk human papillomaviruses (hrHPV) are responsible for anogenital and oropharyngeal cancers, which together account for at least 5% of cancers worldwide. Industrialised nations have benefitted from highly effective screening for the prevention of cervical cancer in recent decades, yet this vital intervention remains inaccessible to millions of women in low- and middle-income countries (LMICs), who bear the greatest burden of HPV disease. While there is an urgent need to increase investment in basic health infrastructure and rollout of prophylactic vaccination, there are now unprecedented opportunities to exploit recent scientific and technological advances in screening and treatment of pre-invasive hrHPV lesions and to adapt them for delivery at scale in resource-limited settings. In addition, non-surgical approaches to the treatment of cervical intraepithelial neoplasia and other hrHPV lesions are showing encouraging results in clinical trials of therapeutic vaccines and antiviral agents. Finally, the use of next-generation sequencing to characterise the vaginal microbial environment is beginning to shed light on host factors that may influence the natural history of HPV infections. In this article, we focus on recent advances in these areas and discuss their potential for impact on HPV disease.
Collapse
Affiliation(s)
- Karin Hellner
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK
| | - Lucy Dorrell
- Nuffield Department of Medicine, University of Oxford, NDM Research Building, Old Road Campus, Headington, Oxford, UK
- Oxford NIHR Biomedical Research Centre, University of Oxford, The Joint Research Office, Block 60, Churchill Hospital, Old Road, Headington, Oxford, UK
| |
Collapse
|
24
|
Sohrabi A, Hajia M. Cervical Cancer and Genital Infections: Assessment of Performance and Validation in Human Papillomavirus Genotyping Assays in Iran, its Neighbouring Countries and Persian Gulf Area. IRANIAN JOURNAL OF PATHOLOGY 2017; 12:35-44. [PMID: 29760751 PMCID: PMC5938722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 08/25/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The accuracy of diagnostic assays in Human Papillomavirus (HPV) genital infection and cervical cancer has remained a clinical challenge in diagnosis. Evidence indicates that a large proportion of cervical cancer can be prevented through organized care for HPV and testing. Countries with low per capita income, such as Iran and its neighbours, have no national organized program for cervical cancer screening and vaccination. The aim of this study was to review recent published papers in this region for evaluating the efficacy of released data regarding HPV genotyping system in genital infections and cervical cancer. METHODS Investigating various medical search engines retrieved 46 reports, mostly after 2010, consisting of either home brew protocols or commercial technologies in this field. RESULTS Summarized results demonstrated that except a few cases, all reports were limited studies performed in confined populations focusing on attending patients at clinics for regular checkups. In the present study, 52.8% of papers were from Iran and the rest belonged to other countries. The rate of HPV infection was reported in the range of 0.62% to 25% in the normal population, while it varied from 18.75% to 100% in females with cervical cancer. In HPV genotyping surveys, only 26.1 % (12/46) of reports had validated and World Health Organization (WHO) proficient procedures. Also, multiple infections were not mentioned in 56.52% (25/46) of researches. CONCLUSIONS Employing reliable genotyping methods is the best way for regular screening of cervical cancer related to HPV and precancerous diseases in females of these areas. The focus of most surveys was to come up with the best national policies for establishing a preventive program in Iran and Persian Gulf area.
Collapse
Affiliation(s)
- Amir Sohrabi
- Dept. of Molecular Biology, Research Center of Health Reference Laboratory, Ministry of Health and Medical Education, Tehran, Iran
| | - Masoud Hajia
- Dept. of Molecular Biology, Research Center of Health Reference Laboratory, Ministry of Health and Medical Education, Tehran, Iran
| |
Collapse
|
25
|
Simms KT, Hall M, Smith MA, Lew JB, Hughes S, Yuill S, Hammond I, Saville M, Canfell K. Optimal Management Strategies for Primary HPV Testing for Cervical Screening: Cost-Effectiveness Evaluation for the National Cervical Screening Program in Australia. PLoS One 2017; 12:e0163509. [PMID: 28095411 PMCID: PMC5240951 DOI: 10.1371/journal.pone.0163509] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 09/10/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Several countries are implementing a transition to HPV testing for cervical screening in response to the introduction of HPV vaccination and evidence indicating that HPV screening is more effective than cytology. In Australia, a 2017 transition from 2-yearly conventional cytology in 18-20 to 69 years to 5-yearly primary HPV screening in 25 to 74 years will involve partial genotyping for HPV 16/18 with direct referral to colposcopy for this higher risk group. The objective of this study was to determine the optimal management of women positive for other high-risk HPV types (not 16/18) ('OHR HPV'). METHODS We used a dynamic model of HPV transmission, vaccination, natural history and cervical screening to determine the optimal management of women positive for OHR HPV. We assumed cytology triage testing was used to inform management in this group and that those with high-grade cytology would be referred to colposcopy and those with negative cytology would receive 12-month surveillance. For those with OHR HPV and low-grade cytology (considered to be a single low-grade category in Australia incorporating ASC-US and LSIL), we evaluated (1) the 20-year risk of invasive cervical cancer assuming this group are referred for 12-month follow-up vs. colposcopy, and compared this to the risk in women with low-grade cytology under the current program (i.e. an accepted benchmark risk for 12-month follow-up in Australia); (2) the population-level impact of the whole program, assuming this group are referred to 12-month surveillance vs. colposcopy; and (3) the cost-effectiveness of immediate colposcopy compared to 12-month follow-up. Evaluation was performed both for HPV-unvaccinated cohorts and cohorts offered vaccination (coverage ~72%). FINDINGS The estimated 20-year risk of cervical cancer is ≤1.0% at all ages if this group are referred to colposcopy vs. ≤1.2% if followed-up in 12 months, both of which are lower than the ≤2.6% benchmark risk in women with low-grade cytology in the current program (who are returned for 12-month follow-up). At the population level, immediate colposcopy referral provides an incremental 1-3% reduction in cervical cancer incidence and mortality compared with 12-month follow-up, but this is in the context of a predicted 24-36% reduction associated with the new HPV screening program compared to the current cytology-based program. Furthermore, immediate colposcopy substantially increases the predicted number of colposcopies, with >650 additional colposcopies required to avert each additional case of cervical cancer compared to 12-month follow-up. Compared to 12-month follow-up, immediate colposcopy has an incremental cost-effectiveness ratio (ICER) of A$104,600/LYS (95%CrI:A$100,100-109,100) in unvaccinated women and A$117,100/LYS (95%CrI:A$112,300-122,000) in cohorts offered vaccination [Indicative willingness-to-pay threshold: A$50,000/LYS]. CONCLUSIONS In primary HPV screening programs, partial genotyping for HPV16/18 or high-grade triage cytology in OHR HPV positive women can be used to refer the highest risk group to colposcopy, but 12-month follow-up for women with OHR HPV and low-grade cytology is associated with a low risk of developing cervical cancer. Direct referral to colposcopy for this group would be associated with a substantial increase in colposcopy referrals and the associated harms, and is also cost-ineffective; thus, 12-month surveillance for women with OHR HPV and low-grade cytology provides the best balance between benefits, harms and cost-effectiveness.
Collapse
Affiliation(s)
- Kate T. Simms
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Michaela Hall
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Megan A. Smith
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- School of Public Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Jie-Bin Lew
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Suzanne Hughes
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
| | - Susan Yuill
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
| | - Ian Hammond
- Steering Committee for the Renewal Implementation Project, National Cervical Screening Program, Department of Health, Canberra, Australian Capital Territory, Australia
- School of Women's and Infants' Health, University of Western Australia, Perth, Western Australia, Australia
| | - Marion Saville
- Victorian Cytology Service, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- School of Public Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
26
|
Montealegre JR, Mullen PD, L Jibaja-Weiss M, Vargas Mendez MM, Scheurer ME. Feasibility of Cervical Cancer Screening Utilizing Self-sample Human Papillomavirus Testing Among Mexican Immigrant Women in Harris County, Texas: A Pilot Study. J Immigr Minor Health 2016; 17:704-12. [PMID: 25358741 DOI: 10.1007/s10903-014-0125-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Here we evaluate the acceptability and feasibility of self-sample human papillomavirus (HPV) testing (self-HPV) among a sample of predominantly Mexican immigrant women who never or sporadically attend for Pap testing. Immigrant women who had not had a Pap test in the past 3 years (n = 100) were recruited. Participants self-collected a cervical sample for HPV testing. High-risk (HR) HPV-positive women were referred for clinical follow-up. Acceptability of self-HPV was high, with 99% reporting that they would be willing to use self-HPV regularly. Nineteen women (19%) tested positive for HR-HPV. Of these, 50% obtained clinical follow-up within 3 months. For those who did not, the primary barrier to follow-up was difficulty obtaining healthcare coverage. In conclusion, self-HPV is highly acceptable to Mexican immigrant women who otherwise do not attend for Pap testing. While the approach addresses critical barriers to primary screening, questions remain as to whether uninsured HR-HPV positive women are able to attend for clinical follow-up.
Collapse
Affiliation(s)
- Jane R Montealegre
- Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, MS: BCM 305, Houston, TX, 77030, USA,
| | | | | | | | | |
Collapse
|
27
|
Zhang Q, Liu YJ, Hu SY, Zhao FH. Estimating long-term clinical effectiveness and cost-effectiveness of HPV 16/18 vaccine in China. BMC Cancer 2016; 16:848. [PMID: 27814703 PMCID: PMC5097411 DOI: 10.1186/s12885-016-2893-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 10/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) 16 and 18 are the two most common HPV oncogenic types that can be prevented by vaccination. This study aimed at assessing the cost-effectiveness of 3 doses of the bivalent HPV vaccine in rural and urban settings in China. METHODS A Markov model was adapted to reflect the lifetime of a modelled 100,000 12-year-old girls cohort in rural and urban settings in China. Input parameters were obtained from published literature, official reports and a two-round expert review panel. Clinical and economic outcomes of vaccination at age 12 with screening was compared to screening only. In the base case analysis, a 3 % discount rate, the vaccine cost of 247 CNY (US$ 39, PAHO vaccine cost in 2013), two rounds of screening in a life time and 70 % coverage for both screening and vaccination were used. One-way, two-way and probabilistic sensitivity analyses were performed. We used different thresholds of cost-effectiveness to reflect the diversity of economic development in China. RESULTS Vaccination in addition to screening could prevent 60 % more cervical cancer cases and deaths than screening only. The incremental cost effectiveness ratio varied largely when changing cost of vaccination and discount in one way analysis. Vaccination was very cost-effective when the vaccine cost ranged 87-630 CNY (US$ 13.8-100) in rural and 87-750 CNY (US$ 13.8-119) in urban; and remained cost-effective when the vaccine cost ranged 630-1,700 CNY (US$ 100-270) in rural and 750-1,900 CNY (US$ 119-302) in urban in two way analysis. Probabilistic sensitivity analyses showed that model results were robust. CONCLUSIONS In both rural and urban, the vaccination cost and discounting are important factors determining the cost-effectiveness of HPV vaccination; policy makers in China should take these into account when making a decision on the introduction of HPV vaccine. In areas with a high burden of cervical cancer and limited screening activities, HPV vaccination should be prioritized. However, the vaccine cost needs to be reduced in order to make it very cost-effective and affordable as well, in particular in poverty areas with high disease burden.
Collapse
Affiliation(s)
- Qian Zhang
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yi-Jun Liu
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
- Department of Preventive Medicine, School of Public Health, Zunyi Medical College, Zunyi, 563099, China
| | - Shang-Ying Hu
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Fang-Hui Zhao
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| |
Collapse
|
28
|
Tuerxun G, Yukesaier A, Lu L, Aierken K, Mijiti P, Jiang Y, Abulizi A, Zhang Y, Abuduxikuer G, Abulizi G, Li H. Evaluation of careHPV, Cervista Human Papillomavirus, and Hybrid Capture 2 Methods in Diagnosing Cervical Intraepithelial Neoplasia Grade 2+ in Xinjiang Uyghur Women. Oncologist 2016; 21:825-31. [PMID: 27317575 DOI: 10.1634/theoncologist.2015-0447] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 01/29/2016] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The study aimed to evaluate the value of the Cervista human papillomavirus (HPV), Hybrid Capture 2 (HC-2), and careHPV tests in diagnosing cervical intraepithelial neoplasia grade 2 (CIN2) or worse in Xinjiang Uyghur women. METHODS Three high-risk human papillomavirus (HR-HPV) detection methods were studied on two different populations by different combination modes; a cytology specimen was obtained at the same time. An abnormal result of any test resulted in referral to colposcopy. Cervical biopsy was also performed. RESULTS In population 1, HR-HPV-positive rates were 57.6% and 54.3% as detected by HC-2 and Cervista, respectively; κ = 0.892 for consistency check of HC-2 and Cervista (p < .001). Area under the receiver operating characteristic curve (AUC) of HC-2 and Cervista was 0.744 (95% confidence interval [CI]: 0.664∼0.824, p < .001) and 0.786 (95% CI: 0.715∼0.858, p < .001), respectively, for diagnosing CIN2+. The A9 probe can detect six subtypes of HPV, including HPV16, HPV31, HPV33, HPV35, HPV52, and HPV58. If one or more of these subtypes are postitive, then A9 will be positive. A diagnosis of class A9 by the Cerevista test correlated with pathological interpretations (chi-square = 43.063, p < .001). In population 2, HR-HPV-positive rates were 40.1% and 34.4%, respectively, by HC-2 and careHPV; κ value was 0.779 for the two tests (p < .001). AUC of HC-2 was 0.895 (95% CI: 0.849∼0.940, p < .001), and careHPV was 0.841 (95% CI: 0.770∼0.899, p < .001) for diagnosing CIN2+. CONCLUSION Good consistency was shown between HC-2 and Cervista tests and also between the HC-2 and careHPV tests. In the detection of CIN2+, Cervista showed better specificity than HC-2, and interpretation of the A9 subgroup showed high predicted value. The HC-2 test demonstrated better sensitivity than careHPV in detection of CIN2+. HC-2, Cervista, and careHPV may be applied as a triage test for visual inspection with acetic acid/Lugol's iodine-positive or ThinPrep cytologic test-positive women. The careHPV test was comparatively economical and efficient and may be more suitable for resource-limited regions, such as Xinjiang. IMPLICATIONS FOR PRACTICE This study was designed to evaluate the value of the Cervista human papillomavirus (HPV), Hybrid Capture 2 (HC-2), and careHPV tests in diagnosing cervical intraepithelial neoplasia grade 2 (CIN2) or worse (CIN2+) lesions in Xinjiang Uyghur women. Results showed that there was good consistency between the HC-2 and Cervista tests, as well as between the HC-2 and careHPV tests. In detecting CIN2+, Cervista had higher specificity than HC-2, whereas analysis of the A9 subgroup had high predictive value. (The A9 probe can detect six subtypes of HPV, including HPV16, HPV31, HPV33, HPV35, HPV52, and HPV58. If one or more of these subtypes are postitive, then A9 will be positive.) The HC-2 test demonstrated better sensitivity than careHPV in detecting CIN2+. HC-2, Cervista, and careHPV could be applied as a triage test for visual inspection with acetic acid/Lugol's iodine-positive or ThinPrep cytologic test-positive women. The careHPV test was comparatively economical and efficient and may be more suitable for resource-limited regions, such as Xinjiang.
Collapse
Affiliation(s)
- Gulixian Tuerxun
- Fifth Department of Gynecology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xi'anjiang Uygur, People's Republic of China
| | - Awaguli Yukesaier
- Fifth Department of Gynecology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xi'anjiang Uygur, People's Republic of China
| | - Ling Lu
- Fifth Department of Gynecology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xi'anjiang Uygur, People's Republic of China
| | - Kailibinuer Aierken
- Fifth Department of Gynecology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xi'anjiang Uygur, People's Republic of China
| | - Patiman Mijiti
- Fifth Department of Gynecology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xi'anjiang Uygur, People's Republic of China
| | - Yujie Jiang
- Department of Gynecology, 12th Hospital of Xi'an City, Xi'an, Shaanxi, People's Republic of China
| | - Axianguli Abulizi
- Clinical Laboratory Center, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uyghur, People's Republic of China
| | - Yuanyuan Zhang
- Fifth Department of Gynecology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xi'anjiang Uygur, People's Republic of China
| | - Guzhanuer Abuduxikuer
- Fifth Department of Gynecology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xi'anjiang Uygur, People's Republic of China
| | - Guzhalinuer Abulizi
- Fifth Department of Gynecology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xi'anjiang Uygur, People's Republic of China
| | - Hua Li
- Fifth Department of Gynecology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xi'anjiang Uygur, People's Republic of China
| |
Collapse
|
29
|
Smith MA, Gertig D, Hall M, Simms K, Lew JB, Malloy M, Saville M, Canfell K. Transitioning from cytology-based screening to HPV-based screening at longer intervals: implications for resource use. BMC Health Serv Res 2016; 16:147. [PMID: 27112193 PMCID: PMC4845438 DOI: 10.1186/s12913-016-1375-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 04/05/2016] [Indexed: 12/22/2022] Open
Abstract
Background Following a recent major review of cervical screening, from 2017 Australia will transition from two-yearly cytology-based screening to five-yearly primary HPV screening, with partial genotyping and direct referral for HPV 16/18 and LBC triage for other oncogenic types. Switching to a longer screening interval will result in transitional fluctuations for volumes of tests before a 'steady state' is reached for the new test volumes. This study aimed to quantify the impact of this transition on year-to-year volumes of screening and follow-up tests and procedures. Methods Number of women screened and test volumes from 2015 to 2032 were estimated via a detailed simulation model which explicitly modelled varying screening and HPV vaccination exposure in individual birth cohorts, and fully incorporated how a relatively rapid screening program switch in 2017 would affect both women attending for routine screening and those in surveillance following an abnormality. Results Numbers of women screened and HPV tests are predicted to fluctuate in the first screening rounds as a result of the transition to a longer screening interval (mean women screened and HPV tests 1.4 million in the first 5-year period, year-to-year fluctuation > +/−50 %; mean 1.5 million women/HPV tests in third 5-year period, fluctuation approximately +/−25 %). The extent to which this fluctuation was predicted to carry through to secondary tests/procedures was less (fluctuations of +25 %/-31 % in first 5-year period; decreasing to +8 %/-10 % by third round). HPV vaccination is predicted to counteract increases in high grade cytology results, colposcopies and precancer treatments which would otherwise occur due to population increases. Precancer treatments are predicted to drop below 2015 levels within the first few years of program switchover. Mean colposcopy volumes are predicted to be similar to 2015 levels by the third round of HPV-based screening, and also be 25–40 % lower than would have occurred in the absence of HPV vaccination. Conclusions While numbers of women attending for screening and HPV tests are anticipated to initially fluctuate as a result of the transition to a longer recommended interval, there is expected to be less fluctuation in follow-up tests and procedures; however these will still have a significant impact on operational aspects of the screening program. Detailed modelling of the switchover process gave important insights into how volumes would be affected. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1375-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Megan A Smith
- Cancer Research Division, Cancer Council NSW, 153 Dowling St, Sydney, NSW, 2011, Australia. .,School of Public Health, University of Sydney, Sydney, Australia.
| | - Dorota Gertig
- Victorian Cytology Service Ltd., Melbourne, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Michaela Hall
- Cancer Research Division, Cancer Council NSW, 153 Dowling St, Sydney, NSW, 2011, Australia
| | - Kate Simms
- Cancer Research Division, Cancer Council NSW, 153 Dowling St, Sydney, NSW, 2011, Australia
| | - Jie-Bin Lew
- Cancer Research Division, Cancer Council NSW, 153 Dowling St, Sydney, NSW, 2011, Australia
| | - Michael Malloy
- Victorian Cytology Service Ltd., Melbourne, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Marion Saville
- Victorian Cytology Service Ltd., Melbourne, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, 153 Dowling St, Sydney, NSW, 2011, Australia.,School of Public Health, University of Sydney, Sydney, Australia
| |
Collapse
|
30
|
Liu YJ, Zhang Q, Hu SY, Zhao FH. Effect of vaccination age on cost-effectiveness of human papillomavirus vaccination against cervical cancer in China. BMC Cancer 2016; 16:164. [PMID: 26919850 PMCID: PMC4768405 DOI: 10.1186/s12885-016-2207-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 02/20/2016] [Indexed: 01/09/2023] Open
Abstract
Background The cost-effectiveness of human papillomavirus (HPV) vaccination in women pre-sexual debut has been demonstrated in many countries. This study aimed to estimate the cost-effectiveness of a 3-dose bivalent HPV vaccination at ages 12 to 55 year in both rural and urban settings in China. Methods The Markov cohort model simulated the natural history of HPV infection and included the effect of screening and HPV vaccination over the lifetime of a 100,000 female cohort. Transition probabilities and utilities were obtained from published literature. Cost data were estimated by Delphi panel using healthcare payers’ perspective. Vaccine cost was assumed Hong Kong listed price. Vaccine efficacy (VE) was based on the PATRICIA trial data assuming VE irrespective of HPV type at all ages on incident HPV. Costs and outcomes were discounted at 3 %. Cervical cancer cases and incremental cost-effectiveness ratio (ICER) for vaccination and screening compared with screening alone were estimated for each vaccination age. Reduced VE in women post-sexual debut were investigated in scenario analyses. Results With 70 % vaccination coverage, a reduction of cancer cases varying from 585 to 33 in rural and 691 to 32 in urban were estimated at ages 12 to 55, respectively. The discounted ICERs of vaccination at any age under 23 years in rural and any age under 25 years in urban were lower than the current threshold. Scenario analyses with lower VE post-sexual debut confirmed the results with age 20 in rural and 21 in urban had consistent lower ICERs. The more ‘catch-up’ cohorts vaccinated at the start of a program, the more cancer lesions are avoided in the long-term. Conclusions Vaccination at any age under 23 years old in rural and any age under 25 years old in urban were cost-effective. Catch-up to the age of 25 years in rural and urban could still be cost-effective. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2207-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Yi-Jun Liu
- Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), 17 South Panjiayuan Lane, P.O. Box 2258, Beijing, 100021, China.,Department of Preventive Medicine, School of Public Health, Zunyi Medical College, 201 Dalian Road, Zunyi, 563099, China
| | - Qian Zhang
- Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), 17 South Panjiayuan Lane, P.O. Box 2258, Beijing, 100021, China
| | - Shang-Ying Hu
- Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), 17 South Panjiayuan Lane, P.O. Box 2258, Beijing, 100021, China.
| | - Fang-Hui Zhao
- Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), 17 South Panjiayuan Lane, P.O. Box 2258, Beijing, 100021, China
| |
Collapse
|
31
|
Catarino R, Petignat P, Dongui G, Vassilakos P. Cervical cancer screening in developing countries at a crossroad: Emerging technologies and policy choices. World J Clin Oncol 2015; 6:281-290. [PMID: 26677441 PMCID: PMC4675913 DOI: 10.5306/wjco.v6.i6.281] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/03/2015] [Accepted: 10/27/2015] [Indexed: 02/06/2023] Open
Abstract
Cervical cancer (CC) represents the fourth most common malignancy affecting women all over the world and is the second most common in developing areas. In these areas, the burden from disease remains important because of the difficulty in implementing cytology-based screening programmes. The main obstacles inherent to these countries are poverty and a lack of healthcare infrastructures and trained practitioners. With the availability of new technologies, researchers have attempted to find new strategies that are adapted to low- and middle-income countries (LMIC) to promote early diagnosis of cervical pathology. Current evidence suggests that human papillomavirus (HPV) testing is more effective than cytology for CC screening. Therefore, highly sensitive tests have now been developed for primary screening. Rapid molecular methods for detecting HPV DNA have only recently been commercially available. This constitutes a milestone in CC screening in low-resource settings because it may help overcome the great majority of obstacles inherent to previous screening programmes. Despite several advantages, HPV-based screening has a low positive predictive value for CC, so that HPV-positive women need to be triaged with further testing to determine optimal management. Visual inspection tests, cytology and novel biomarkers are some options. In this review, we provide an overview of current and emerging screening approaches for CC. In particular, we discuss the challenge of implementing an efficient cervical screening adapted to LMIC and the opportunity to introduce primary HPV-based screening with the availability of point-of-care (POC) HPV testing. The most adapted screening strategy to LMIC is still a work in progress, but we have reasons to believe that POC HPV testing makes part of the future strategies in association with a triage test that still needs to be defined.
Collapse
|
32
|
An extended cost-effectiveness analysis of publicly financed HPV vaccination to prevent cervical cancer in China. Vaccine 2015; 33:2830-41. [DOI: 10.1016/j.vaccine.2015.02.052] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 02/13/2015] [Accepted: 02/18/2015] [Indexed: 01/31/2023]
|
33
|
Mendes D, Bains I, Vanni T, Jit M. Systematic review of model-based cervical screening evaluations. BMC Cancer 2015; 15:334. [PMID: 25924871 PMCID: PMC4419493 DOI: 10.1186/s12885-015-1332-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 04/22/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Optimising population-based cervical screening policies is becoming more complex due to the expanding range of screening technologies available and the interplay with vaccine-induced changes in epidemiology. Mathematical models are increasingly being applied to assess the impact of cervical cancer screening strategies. METHODS We systematically reviewed MEDLINE®, Embase, Web of Science®, EconLit, Health Economic Evaluation Database, and The Cochrane Library databases in order to identify the mathematical models of human papillomavirus (HPV) infection and cervical cancer progression used to assess the effectiveness and/or cost-effectiveness of cervical cancer screening strategies. Key model features and conclusions relevant to decision-making were extracted. RESULTS We found 153 articles meeting our eligibility criteria published up to May 2013. Most studies (72/153) evaluated the introduction of a new screening technology, with particular focus on the comparison of HPV DNA testing and cytology (n = 58). Twenty-eight in forty of these analyses supported HPV DNA primary screening implementation. A few studies analysed more recent technologies - rapid HPV DNA testing (n = 3), HPV DNA self-sampling (n = 4), and genotyping (n = 1) - and were also supportive of their introduction. However, no study was found on emerging molecular markers and their potential utility in future screening programmes. Most evaluations (113/153) were based on models simulating aggregate groups of women at risk of cervical cancer over time without accounting for HPV infection transmission. Calibration to country-specific outcome data is becoming more common, but has not yet become standard practice. CONCLUSIONS Models of cervical screening are increasingly used, and allow extrapolation of trial data to project the population-level health and economic impact of different screening policy. However, post-vaccination analyses have rarely incorporated transmission dynamics. Model calibration to country-specific data is increasingly common in recent studies.
Collapse
Affiliation(s)
- Diana Mendes
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, Bloomsbury, London, WC1E 7HT, UK.
- Modelling and Economics Unit, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.
| | - Iren Bains
- Modelling and Economics Unit, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.
| | - Tazio Vanni
- Brazilian Ministry of Health, Esplanada dos Ministérios Bloco G, Brasília-DF, CEP: 70058-900, Brasil.
| | - Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, Bloomsbury, London, WC1E 7HT, UK.
- Modelling and Economics Unit, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.
| |
Collapse
|
34
|
Zahedi L, Sizemore E, Malcolm S, Grossniklaus E, Nwosu O. Knowledge, attitudes and practices regarding cervical cancer and screening among Haitian health care workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:11541-52. [PMID: 25390794 PMCID: PMC4245628 DOI: 10.3390/ijerph111111541] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 11/04/2014] [Accepted: 11/05/2014] [Indexed: 11/28/2022]
Abstract
It is estimated that Haiti has the highest incidence of cervical cancer in the Western Hemisphere. There are currently no sustainable and affordable cervical cancer screening programs in Haiti. The current status of screening services and knowledge of health care professionals was assessed through a Knowledge, Attitudes, and Practices survey on cervical cancer screening and prevention. It was distributed to Project Medishare for Haiti health care workers (n = 27) in the Central Plateau. The majority (22/27) of participants stated pre-cancerous cells could be detected through screening, however, only four had ever performed a pap smear. All of the participants felt a screening program should be started in their area. Our data establishes that knowledge is fairly lacking among healthcare workers and there is an opportunity to train them in simple, cost effective "screen-and-treat" programs that could have a great impact on the overall health of the population.
Collapse
Affiliation(s)
- Leilah Zahedi
- Department of Obstetrics and Gynecology, Emory University, 69 Jesse Hill Junior Drive South East, Atlanta, GA 30303, USA.
| | - Emma Sizemore
- Rollins School of Public Health, Emory University, 1518 Clifton Rd. North East, Atlanta, GA 30322, USA.
| | - Stuart Malcolm
- School of Medicine, Emory University, 201 Dowman Drive, Atlanta, GA 30322, USA.
| | - Emily Grossniklaus
- School of Medicine, Emory University, 201 Dowman Drive, Atlanta, GA 30322, USA.
| | - Oguchi Nwosu
- Department of Family and Preventive Medicine, Emory University, 201 Dowman Drive, Atlanta, GA 30322, USA.
| |
Collapse
|
35
|
Nahvijou A, Sari AA, Zendehdel K, Marnani AB. Management of precancerous cervical lesions in iran: a cost minimizing study. Asian Pac J Cancer Prev 2014; 15:8209-13. [PMID: 25339007 DOI: 10.7314/apjcp.2014.15.19.8209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cervical cancer is a common, preventable and manageable disease in women worldwide. OBJECTIVES This study was conducted to determine the cost of follow-up for suspicious precancerous cervical lesions within a screening program using Pap smear or HPV DNA test through the decision tree. MATERIALS AND METHODS Patient follow-up processes were determined using standard guidelines and consultation with specialists to design a decision tree model. Costs of treatment in both public and private sectors were identified according to the national tariffs in 2010 and determined based on decision tree and provided services (visits to specialists, colposcopy, and conization) with two modalities: Pap smear and HPV DNA test. The number of patients and the mean cost of treatment in each sector were calculated. The prevalence of lesions and HPV were obtained from literature to estimate the cost of treatment for each woman in the population. RESULTS Follow-up costs were determined using seven processes for Pap smear and 11 processes for HPV DNA test. The total cost of using Pap smear and HPV DNA process for each woman in the population was 36.1$ and 174 $ respectively. CONCLUSIONS The follow-up process for patients with suspicious cervical lesions needs to be included in the existing screening program. HPV DNA test is currently more expensive than Pap smear, it is suggested that we manage precancerous cervical lesions with this latter test.
Collapse
Affiliation(s)
- Azin Nahvijou
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran E-mail :
| | | | | | | |
Collapse
|
36
|
Huang W, Liu G, Zhang X, Fu W, Zheng S, Wu Q, Liu C, Liu Y, Cai S, Huang Y. Cost-effectiveness of colorectal cancer screening protocols in urban Chinese populations. PLoS One 2014; 9:e109150. [PMID: 25285526 PMCID: PMC4186806 DOI: 10.1371/journal.pone.0109150] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 08/29/2014] [Indexed: 12/31/2022] Open
Abstract
Colorectal cancer (CRC) takes a second and fourth position in the incidence and mortality lists respectively among all malignant tumors in urban populations in China. This study was designed to evaluate the cost-effectiveness of two different CRC screening protocols: faecal occult blood test (FOBT) alone, and FOBT plus a high-risk factor questionnaire (HRFQ) as the respective initial screens, followed by colonoscopy. We developed a Markov model to simulate the progression of a cohort of 100,000 average risk asymptomatic individuals moving through a defined series of states between the ages of 40 to 74 years. The parameters used for the modeling came from the CESP (Comparison and Evaluation of Screening Programs for Colorectal Cancer in Urban Communities in China) study and published literature. Eight CRC screening scenarios were tested in the Markov model. The cost-effectiveness of CRC screening under each scenario was measured by an incremental cost-effectiveness ratio (ICER) compared with a scenario without CRC screening. The study revealed that a combined use of FOBT and HRFQ is preferable in CRC screening programs as an initial screening instrument. Annual FOBT+HRFQ screening is recommended for those who have a negative initial result and those who have a positive result but have failed to continue to colonoscopic examination. Repeated colonoscopy (for those with a positive result in initial screening but a negative colonoscopy result) should be performed at a ten-year interval instead of one-year. Such a protocol would cost 7732 Yuan per life year saved, which is the most cost-effective option. In conclusion, the current Chinese Trial Version for CRC Screening Strategy should be revised in line with the most cost-effective protocol identified in this study.
Collapse
Affiliation(s)
- Weidong Huang
- School of Health Management, Harbin Medical University, Nangang District, Harbin, China
| | - Guoxiang Liu
- School of Health Management, Harbin Medical University, Nangang District, Harbin, China
| | - Xin Zhang
- School of Health Management, Harbin Medical University, Nangang District, Harbin, China
| | - Wenqi Fu
- School of Health Management, Harbin Medical University, Nangang District, Harbin, China
| | - Shu Zheng
- Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, Ministry of Education of China; Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qunhong Wu
- School of Health Management, Harbin Medical University, Nangang District, Harbin, China
| | - Chaojie Liu
- School of Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Yang Liu
- School of Health Management, Harbin Medical University, Nangang District, Harbin, China
| | - Shanrong Cai
- Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, Ministry of Education of China; Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yanqin Huang
- Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, Ministry of Education of China; Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
37
|
Lin CQ, Chen F, Liu B, Zhang YZ, Cui XL, Li AM, Zhang WH, Chen W, Chang I, Sivasubramaniam P, Zhu J, Qiao YL. A parallel study of careHPV and Hybrid Capture 2 human papillomavirus DNA testing for cervical cancer screening in rural China. J Virol Methods 2014; 202:73-8. [DOI: 10.1016/j.jviromet.2014.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 03/01/2014] [Accepted: 03/04/2014] [Indexed: 11/16/2022]
|
38
|
Zhao ZM, Pan XF, Lv SH, Xie Y, Zhang SK, Qiao YL, Qi XR, Yang CX, Zhao FH. Quality of life in women with cervical precursor lesions and cancer: a prospective, 6-month, hospital-based study in China. CHINESE JOURNAL OF CANCER 2014; 33:339-45. [PMID: 24698497 PMCID: PMC4110466 DOI: 10.5732/cjc.013.10139] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The overall survival of patients with cervical cancer has improved due to detection at an early stage and availability of comprehensive treatments in China. As patients' lives prolonged, it is important to understand their health-related quality of life (QoL) during and after treatment. We used the EQ-5D questionnaire to assess QoL of 194 patients with cervical lesions at Sichuan University West China Second Hospital between May 2010 and January 2011. Patients were surveyed before primary treatment and at 1, 3, and 6 months after primary treatment. Results showed a consistent decline in EQ-5D scores in the spectrum of cervical lesions at each time point after treatment (all P < 0.05). For patients with precursor lesions, there was an increasing trend along the timeline of treatment (P < 0.01). For patients with early-stage cervical cancer, EQ-5D scores declined in the first month (P = 0.01) and gradually increased to higher levels at 6 months post-treatment than those before treatment (P < 0.01). EQ-5D scores followed a similar trend in patients with advanced cervical cancer (P = 0.04), though they did not statistically rebound after 6 months (0.84 ± 0.19 vs. 0.86 ± 0.11, P = 0.62). Regarding advanced cervical cancer, EQ-5D scores for women above 40 years of age appeared to recover more rapidly and reached higher levels than those for women below 40 years (P = 0.03). Caution and extra care are recommended in the early period of cervical cancer treatment given the slight deterioration in the QoL, and in particular, for younger cervical cancer patients. Our study implies that health care providers may need to improve the health-related QoL of cervical cancer patients.
Collapse
Affiliation(s)
- Zhi-Mei Zhao
- Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, Sichuan 610041, P. R. China.
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Cho E, Kang MH, Choi KS, Suh M, Jun JK, Park EC. Cost-effectiveness of Korea's National Cervical Cancer Screening Program. Asian Pac J Cancer Prev 2014; 14:4329-34. [PMID: 23991998 DOI: 10.7314/apjcp.2013.14.7.4329] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cervical cancer, which is common in developing countries, is also a major health issue in Korea. Our aim was to evaluate the cost-effectiveness of Korea's National Cancer Screening Program (NCSP), implemented in 1999. MATERIALS AND METHODS The target population was Korean women 30 years or over who were invited to take part in the NCSP in 2002-2007. By merging NCSP records with Korean Central Cancer Registry data, patients diagnosed with cervical cancer who had been screened were assigned to a "screened group, " while patients diagnosed elsewhere were assigned to a "non-screened group. " Clinical outcomes were measured in terms of life-years saved (LYS), derived from 5-year mortality rates supplied by the Korean National Health Insurance Corporation and National Statistical Office. Direct and travel costs associated with screening were evaluated from the perspective of the payer, the NCSP. RESULTS A diagnosis via screening was associated with 2.30 LYS, and the incremental cost-effectiveness ratio (ICER) estimate for screening was 7,581,679 KW/LYS (6,727 USD/LYS). ICER estimates were lower for older patients (≥ 50 years) than younger patients (4,047,033 KW/ LYS vs 5,680,793 KW/LYS). The proportion of early-stage cancers detected was 16.3% higher in the screened group. CONCLUSIONS In light of Korea's per capita gross domestic product (32,272 USD in 2012), the current NCSP's incremental cost per LYS appears acceptable.
Collapse
Affiliation(s)
- Eun Cho
- College of Pharmacy, Sookmyung Women's University, Seoul, Korea.
| | | | | | | | | | | |
Collapse
|
40
|
Cuschieri K. Human papillomavirus testing: the challenges of picking the right tools for the job. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.11.69] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
41
|
Abstract
Cervical cancer is both preventable and curable, yet it remains one of the leading causes of mortality in women worldwide. Approximately 88% of cervical cancer cases are diagnosed in low-resource countries, yet very few resources are allocated to prevention and treatment programs. In fact, it is estimated that only 5% of women in low-resources countries are screened appropriately for cervical cancer. Cytology-based programs are not feasible because of lack of healthcare infrastructure and cost, thus alternative methods of cancer screening, such as visual inspection with acetic acid and HPV-DNA testing, have been intensively studied and are reviewed in this article.
Collapse
|
42
|
Cuzick J, Bergeron C, von Knebel Doeberitz M, Gravitt P, Jeronimo J, Lorincz AT, J L M Meijer C, Sankaranarayanan R, J F Snijders P, Szarewski A. New technologies and procedures for cervical cancer screening. Vaccine 2013. [PMID: 23199953 DOI: 10.1016/j.vaccine.2012.05.088] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The clearly higher sensitivity and reproducibility of human papillomavirus (HPV) DNA testing for high-grade cervical intraepithelial neoplasia (CIN) has led to widespread calls to introduce it as the primary screening test. The main concern has been its lower specificity, due to the fact that it cannot separate transient from persistent infections, and only the latter are associated with an increased risk of high-grade CIN and cancer. Thus, even proponents of HPV testing generally only recommend it for women over the age of 30 years (or in some cases 35 years). If HPV testing is to reach its full potential, new approaches with better specificity are needed, either as triage tests for HPV positive women or, if the high sensitivity of HPV DNA testing can be maintained, as alternate primary screening modalities. Approaches that may useful in this regard, especially as triage tests, include HPV typing, methylation (and consequent silencing) of host and viral genes, and new cytologic methods, such as p16(INK4a) staining, which attempt to identify proliferating cells. At an earlier stage of development are direct methods based on detection of HPV E6 or E7 proteins. Recent progress and current status of these methods is discussed in this chapter. The current status of visual inspection (VIA and VILI) methods is also surveyed and progress on self-sampling is reviewed. This article forms part of a special supplement entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.
Collapse
Affiliation(s)
- Jack Cuzick
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Abstract
Developing countries suffer the highest burden of cervical cancers but have the lowest resources. Effective cervical cytology screening programme, along with a network of diagnostic and therapeutic colposcopy centres, like developed countries, is almost impossible to be reproduced in developing countries. Visual inspection methods [e.g., Visual inspection with Lugol’s iodine (VILI) and Visual Inspection with Acetic Acid (VIA)] which are cheaper, require less expertise and have the advantage of possible treatment in one setting have been shown to be effective alternatives. The sensitivity to detect CIN2+, by VIA and VILI, have been shown to be 80% and 91% respectively, with a specificity rate of 92% and 85% respectively. Screening by human papillomavirus (HPV) testing has high sensitivity (96.4%) but low specificity (94.1%) to detect CIN2+, when compared to Pap Smear (sensitivity, 55.4% and specificity, 96.8%). A single lifetime HPV testing in a large unscreened population has been shown to significantly reduce cervical cancer incidence and mortality when compared to cervical cytology, VIA or no screening. HPV testing of self-collected vaginal specimens also helps to overcome religious and socio-cultural barriers towards pelvic examination amongst women in developing countries. Current HPV testing methods are expensive, skill/infrastructure demanding and takes time to produce results. A cheaper HPV test, called careHPV™, which is able to provide results within 2.5 h and requires minimal skill/infrastructure to operate, was designed for use in developing countries. One stop screen and treat facilities using VIA or rapid HPV testing, and cryotherapy, can overcome non-compliance to follow-up which is a major issue in developing countries. Cure rates of 81.4% for CIN1, 71.4% for CIN2 and 68.0% for CIN3 at 6 mo after treatment have been reported. Incorporating telemedicine with cervicography of VIA or VILI or even telecolposcopy, has great potential in cervical cancer screening, especially in countries with vast geographical areas.
Collapse
|
44
|
Lew JB, Howard K, Gertig D, Smith M, Clements M, Nickson C, Shi JF, Dyer S, Lord S, Creighton P, Kang YJ, Tan J, Canfell K. Expenditure and resource utilisation for cervical screening in Australia. BMC Health Serv Res 2012; 12:446. [PMID: 23216968 PMCID: PMC3548768 DOI: 10.1186/1472-6963-12-446] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 11/21/2012] [Indexed: 11/13/2022] Open
Abstract
Background The National Cervical Screening Program in Australia currently recommends that women aged 18–69 years are screened with conventional cytology every 2 years. Publicly funded HPV vaccination was introduced in 2007, and partly as a consequence, a renewal of the screening program that includes a review of screening recommendations has recently been announced. This study aimed to provide a baseline for such a review by quantifying screening program resource utilisation and costs in 2010. Methods A detailed model of current cervical screening practice in Australia was constructed and we used data from the Victorian Cervical Cytology Registry to model age-specific compliance with screening and follow-up. We applied model-derived rate estimates to the 2010 Australian female population to calculate costs and numbers of colposcopies, biopsies, treatments for precancer and cervical cancers in that year, assuming that the numbers of these procedures were not yet substantially impacted by vaccination. Results The total cost of the screening program in 2010 (excluding administrative program overheads) was estimated to be A$194.8M. We estimated that a total of 1.7 million primary screening smears costing $96.7M were conducted, a further 188,900 smears costing $10.9M were conducted to follow-up low grade abnormalities, 70,900 colposcopy and 34,100 histological evaluations together costing $21.2M were conducted, and about 18,900 treatments for precancerous lesions were performed (including retreatments), associated with a cost of $45.5M for treatment and post-treatment follow-up. We also estimated that $20.5M was spent on work-up and treatment for approximately 761 women diagnosed with invasive cervical cancer. Overall, an estimated $23 was spent in 2010 for each adult woman in Australia on cervical screening program-related activities. Conclusions Approximately half of the total cost of the screening program is spent on delivery of primary screening tests; but the introduction of HPV vaccination, new technologies, increasing the interval and changing the age range of screening is expected to have a substantial impact on this expenditure, as well as having some impact on follow-up and management costs. These estimates provide a benchmark for future assessment of the impact of changes to screening program recommendations to the costs of cervical screening in Australia.
Collapse
Affiliation(s)
- Jie-Bin Lew
- Cancer Research Division, Cancer Council NSW, 153 Dowling Street, Woolloomooloo, Sydney, NSW 2011, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Shi JF, Chen JF, Canfell K, Feng XX, Ma JF, Zhang YZ, Zhao FH, Li R, Ma L, Li ZF, Lew JB, Ning Y, Qiao YL. Estimation of the costs of cervical cancer screening, diagnosis and treatment in rural Shanxi Province, China: a micro-costing study. BMC Health Serv Res 2012; 12:123. [PMID: 22624619 PMCID: PMC3461448 DOI: 10.1186/1472-6963-12-123] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 05/24/2012] [Indexed: 11/10/2022] Open
Abstract
Background Cost estimation is a central feature of health economic analyses. The aim of this study was to use a micro-costing approach and a societal perspective to estimate aggregated costs associated with cervical cancer screening, diagnosis and treatment in rural China. Methods We assumed that future screening programs will be organized at a county level (population ~250,000), and related treatments will be performed at county or prefecture hospitals; therefore, this study was conducted in a county and a prefecture hospital in Shanxi during 2008–9. Direct medical costs were estimated by gathering information on quantities and prices of drugs, supplies, equipment and labour. Direct non-medical costs were estimated via structured patient interviews and expert opinion. Results Under the base case assumption of a high-volume screening initiative (11,475 women screened annually per county), the aggregated direct medical costs of visual inspection, self-sampled careHPV (Qiagen USA) screening, clinician-sampled careHPV, colposcopy and biopsy were estimated as US$2.64,$7.49,$7.95,$3.90 and $5.76, respectively. Screening costs were robust to screening volume (<5% variation if 2,000 women screened annually), but costs of colposcopy/biopsy tripled at the lower volume. Direct medical costs of Loop Excision, Cold-Knife Conization and Simple and Radical Hysterectomy varied from $61–544, depending on the procedure and whether conducted at county or prefecture level. Direct non-medical expenditure varied from $0.68–$3.09 for screening/diagnosis and $83–$494 for pre-cancer/cancer treatment. Conclusions Diagnostic costs were comparable to screening costs for high-volume screening but were greatly increased in lower-volume situations, which is a key consideration for the scale-up phase of new programs. The study’s findings will facilitate cost-effectiveness evaluation and budget planning for cervical cancer prevention initiatives in China.
Collapse
Affiliation(s)
- Ju-Fang Shi
- Department of Cancer Epidemiology, Cancer Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, 17 South Panjiayuan Lane, Beijing, Chaoyang District, 100021, China
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Shi JF, Chen JF, Canfell K, Feng XX, Ma JF, Zhang YZ, Zhao FH, Li R, Ma L, Li ZF, Lew JB, Ning Y, Qiao YL. Estimation of the costs of cervical cancer screening, diagnosis and treatment in rural Shanxi Province, China: a micro-costing study. BMC Health Serv Res 2012. [PMID: 22624619 DOI: 10.1186/1472-6963-12–123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cost estimation is a central feature of health economic analyses. The aim of this study was to use a micro-costing approach and a societal perspective to estimate aggregated costs associated with cervical cancer screening, diagnosis and treatment in rural China. METHODS We assumed that future screening programs will be organized at a county level (population ~250,000), and related treatments will be performed at county or prefecture hospitals; therefore, this study was conducted in a county and a prefecture hospital in Shanxi during 2008-9. Direct medical costs were estimated by gathering information on quantities and prices of drugs, supplies, equipment and labour. Direct non-medical costs were estimated via structured patient interviews and expert opinion. RESULTS Under the base case assumption of a high-volume screening initiative (11,475 women screened annually per county), the aggregated direct medical costs of visual inspection, self-sampled careHPV (Qiagen USA) screening, clinician-sampled careHPV, colposcopy and biopsy were estimated as US$2.64,$7.49,$7.95,$3.90 and $5.76, respectively. Screening costs were robust to screening volume (<5% variation if 2,000 women screened annually), but costs of colposcopy/biopsy tripled at the lower volume. Direct medical costs of Loop Excision, Cold-Knife Conization and Simple and Radical Hysterectomy varied from $61-544, depending on the procedure and whether conducted at county or prefecture level. Direct non-medical expenditure varied from $0.68-$3.09 for screening/diagnosis and $83-$494 for pre-cancer/cancer treatment. CONCLUSIONS Diagnostic costs were comparable to screening costs for high-volume screening but were greatly increased in lower-volume situations, which is a key consideration for the scale-up phase of new programs. The study's findings will facilitate cost-effectiveness evaluation and budget planning for cervical cancer prevention initiatives in China.
Collapse
Affiliation(s)
- Ju-Fang Shi
- Department of Cancer Epidemiology, Cancer Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, 17 South Panjiayuan Lane, Beijing, Chaoyang District, 100021, China
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Sankaranarayanan R, Nessa A, Esmy PO, Dangou JM. Visual inspection methods for cervical cancer prevention. Best Pract Res Clin Obstet Gynaecol 2011; 26:221-32. [PMID: 22075441 DOI: 10.1016/j.bpobgyn.2011.08.003] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 08/12/2011] [Indexed: 02/06/2023]
Abstract
The need for simple, cost-effective screening approaches for cervical cancer prevention in low-resource countries has led to the evaluation of visual screening with 3-5% acetic acid. The low reproducibility and wide variation in accuracy reflect the subjective nature of the test. Pooled sensitivity, specificity, positive and negative predictive values were 80%, 92%, 10% and 99%, respectively, for detecting cervical intraepithelial neoplasia grade 2 or worse lesions. Realistic sensitivity of a quality- assured single visual inspection with acetic acid is around 50%. A single round of visual inspection with acetic acid screening has been associated with a 25-35% reduction in cervical cancer incidence and the frequency of cervical intraepithelial neoplasia grade 2 or worse lesions in randomised-controlled trials. Despite all its limitations, implementing visual inspection with acetic acid screening in low-resource countries may provide a pragmatic approach to building up human resources and infrastructure that may facilitate the highly anticipated low-cost, rapid human papilloma virus testing in the near future.
Collapse
Affiliation(s)
- Rengaswamy Sankaranarayanan
- Early Detection and Prevention Section and Screening Group, International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France.
| | | | | | | |
Collapse
|