What's the optimal visual inspection screening intervals for cervical cancer screening in real practice of rural China? A cost-utility modeling study

Abstract

OBJECTIVES: Chinese government initiated a nation-wide cervical screening program, covering 10 million rural women in 221 counties all over the country. The objectives of the present study were to compare costs, health outcomes, and cost-effectiveness of visual inspection with acetic acid (VIA) screening strategies in rural China, and to identify optimal screening intervals for policy makers. METHODS: Markov simulation model was developed to synthesize the evidence of screening and treatment practices in rural China, and applied to predict the long-term costs and effectiveness for hypothetical cohorts over 20 years of screening. Model was validated by calibrating prediction with observation data on age-specific cervical cancer mortality and incidence in China. Costs were considered from a societal perspective while health effects were mainly expressed as quality-adjusted life years (QALY). Both cost and utility were collected on-site and discounted at 5% per year. RESULTS: All completing alternatives showed certain benefits due to the decreased number of women developing cervical cancer. A trend for shorter screening intervals to have greater benefit was found. Under different screening intervals, mortality and incidence were expected to be reduced by 6.67-31.74% and 5.12-23.60%, respectively. Comparing to no screening (status quo), ten-year VIA screening was identified as the most cost-effective option, followed by VIA screening every five-, three- and one year, with corresponding incremental cost-utility ratio (ICUR) ranged from 11,921 to 17,215 CNY (1889 to 2728 US dollars, 2012) per QALY saved. All of the ICURs were much less than China’s GDP per capita (6247 US dollars, 2012). CONCLUSIONS: VIA screening at different intervals were all very cost-effective options for 35-59 years old women in rural China. It is also noted that the cost-effective manner of aselected strategy largely depends on the local economic status and the performance of such organized program. Copyright © 2014 Published by Elsevier Inc.