Changfa Xia1, Xiaoqian Xu1, Xuelian Zhao1, Shangying Hu1, Youlin Qiao1, Yong Zhang1, Raymond Hutubessy2, Partha Basu3, Nathalie Broutet4, Mark Jit5,6, Fanghui Zhao7. 1. National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Pan-jia-yuan South Lane, Chaoyang District, Beijing, 100021, China. 2. Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland. 3. Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France. 4. Department of Reproductive Health and Research - WHO Special Research Programme on Human Reproduction (HRP), World Health Organization, Geneva, Switzerland. 5. Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK. 6. School of Public Health, University of Hong Kong, Hong Kong, Hong Kong SAR, China. 7. National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Pan-jia-yuan South Lane, Chaoyang District, Beijing, 100021, China. zhaofangh@cicams.ac.cn.
Abstract
BACKGROUND: The World Health Assembly has adopted a global strategy to eliminate cervical cancer. However, neither the optimal pathway nor the corresponding economic and health benefits have been evaluated. We take China as an example to assess the optimal pathway towards elimination and the cost-effectiveness of tailored actions. METHODS: A validated hybrid model was used to assess the costs and benefits of alternative strategies combining human papillomavirus vaccination, cervical screening, and treatment of pre-invasive lesions and invasive cancer for females with different immunization history. All Chinese females living or projected to be born during 2015-2100, under projected trends in aging, urbanization, and sexual activity, were considered. Optimal strategies were determined by cost-effectiveness efficiency frontiers. Primary outcomes were cervical cancer cases and deaths averted and incremental cost-effectiveness ratios (ICERs). We employed a lifetime horizon from a societal perspective. One-way and probabilistic sensitivity analyses evaluate model uncertainty. RESULTS: The optimal pathway represents an integration of multiple tailored strategies from females with different immunization history. If China adopts the optimal pathway, the age-standardized incidence of cervical cancer is predicted to decrease to fewer than four new cases per 100,000 women (i.e., elimination) by 2047 (95% confidence interval 2043 to 2050). Compared to the status quo, the optimal pathway would avert a total of 7,509,192 (6,922,744 to 8,359,074) cervical cancer cases and 2,529,873 (2,366,826 to 2,802,604) cervical cancer deaths in 2021-2100, with the discounted ICER being $- 339 (- 687 to - 79) per quality-adjusted life-year. CONCLUSIONS: By adopting an optimal pathway from 2021 (namely, the year of the first Chinese Centennial Goals) onwards, cervical cancer could be eliminated by the late 2040s (namely, ahead of the second Chinese Centennial Goals) while saving net economic costs in China.
BACKGROUND: The World Health Assembly has adopted a global strategy to eliminate cervical cancer. However, neither the optimal pathway nor the corresponding economic and health benefits have been evaluated. We take China as an example to assess the optimal pathway towards elimination and the cost-effectiveness of tailored actions. METHODS: A validated hybrid model was used to assess the costs and benefits of alternative strategies combining humanpapillomavirus vaccination, cervical screening, and treatment of pre-invasive lesions and invasive cancer for females with different immunization history. All Chinese females living or projected to be born during 2015-2100, under projected trends in aging, urbanization, and sexual activity, were considered. Optimal strategies were determined by cost-effectiveness efficiency frontiers. Primary outcomes were cervical cancer cases and deaths averted and incremental cost-effectiveness ratios (ICERs). We employed a lifetime horizon from a societal perspective. One-way and probabilistic sensitivity analyses evaluate model uncertainty. RESULTS: The optimal pathway represents an integration of multiple tailored strategies from females with different immunization history. If China adopts the optimal pathway, the age-standardized incidence of cervical cancer is predicted to decrease to fewer than four new cases per 100,000 women (i.e., elimination) by 2047 (95% confidence interval 2043 to 2050). Compared to the status quo, the optimal pathway would avert a total of 7,509,192 (6,922,744 to 8,359,074) cervical cancer cases and 2,529,873 (2,366,826 to 2,802,604) cervical cancerdeaths in 2021-2100, with the discounted ICER being $- 339 (- 687 to - 79) per quality-adjusted life-year. CONCLUSIONS: By adopting an optimal pathway from 2021 (namely, the year of the first Chinese Centennial Goals) onwards, cervical cancer could be eliminated by the late 2040s (namely, ahead of the second Chinese Centennial Goals) while saving net economic costs in China.
Authors: S Y Tao; J R Peng; Y Wang; G T Zhang; Z Y Chen; F Zhao; J Q Ma; X Yang; Y L Qiao; F H Zhao; C X Yang Journal: Zhonghua Yu Fang Yi Xue Za Zhi Date: 2018-12-06
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Authors: Marc Brisson; Jane J Kim; Karen Canfell; Mélanie Drolet; Guillaume Gingras; Emily A Burger; Dave Martin; Kate T Simms; Élodie Bénard; Marie-Claude Boily; Stephen Sy; Catherine Regan; Adam Keane; Michael Caruana; Diep T N Nguyen; Megan A Smith; Jean-François Laprise; Mark Jit; Michel Alary; Freddie Bray; Elena Fidarova; Fayad Elsheikh; Paul J N Bloem; Nathalie Broutet; Raymond Hutubessy Journal: Lancet Date: 2020-01-30 Impact factor: 79.321
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