Study of multi-center cost estimation of cervical cancer screening in parts of China
LI Yang1,2 CHEN Zhangya3 ZHAO Yuqian4 DANG Le1 CHI Hui2▲ QIAO Youlin1▲ Research Group of Sepecially for Public Welfare Industry of Health Reform
1.Department of Epidemiology, National Cancer Center National Clinical Research Center for Cancer Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China;
2.Department of Health Information Dissemination, Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100005, China;
3.Executive Office, Taiyuan Health Supervision, Shanxi Province, Taiyuan 030001, China;
4.Office of Cancer Prevention and Treatment, Sichuan Cancer Hospital and Institute Sichuan Cancer Control Center School of Medicine, University of Electronic Science and Technology of China, Sichuan Province, Chengdu 610041, China
Abstract：Objective To develop cost estimation for providing financial-based quantitative basis for the sustainable development of cervical cancer screening project. Methods Ten medical pilots institutions were selected from 8 provinces/municipality, as Liaoning, Zhejiang, Guangdong, etc. by convenient sampling for taking time-driven activity-based costing to estimate cost difference between cytological examination and human papillomavirus (HPV) testing screening schemes for cervical cancer. Results The cost of cytological examination, HPV testing and cytology examination after HPV testing accounted for the highest proportion of the cost of consumables were 53.8%, 71.8% and 68.5%, respectively. The other expenses such as the organization was the lowest proportion of project. Between the cost components of colposcopy examination and pathology diagnosis, the manpower cost accounted for the highest proportion as 77.1% and 67.0%, respectively, while followed by consumables and equipment costs. Calculated based on capitation, the average cost per patient of cytological examination was 69.29 yuan per time, while the average cost per patient of cytology examination after HPV testing was 93.67 yuan per time. Sensitivity analysis reviews that manpower costs have the greatest impact on screening costs. Conclusion No matter using cytological examination or HPV testing, considering the sustainability of the project, in addition to the necessary equipment and consumables costs, the investment of personnel and counterpart funds should also be considered.
李扬1,2 陈张娅3 赵宇倩4 党乐1 池慧2▲ 乔友林1▲ 卫生行业科研专项课题组. 中国部分地区子宫颈癌筛查的多中心成本测算研究[J]. 中国医药导报, 2019, 16(32): 22-26.
LI Yang1,2 CHEN Zhangya3 ZHAO Yuqian4 DANG Le1 CHI Hui2▲ QIAO Youlin1▲ Research Group of Sepecially for Public Welfare Industry of Health Reform. Study of multi-center cost estimation of cervical cancer screening in parts of China. 中国医药导报, 2019, 16(32): 22-26.
[1] IARC. Globocan 2012：Estimated cancer incidence，mortality and prevalence worldwide in 2012 [EB/OL]. [2016-02-02]. http：//globocan.iarc.fr/Pages/factsheetscancer.aspx cancer＝cervix.
[2] 胡尚英，郑荣寿，赵方辉，等.1989至2008年中国女性子宫颈癌发病和死亡趋势分析[J].中国医学科学院学报，2014，36（2）：119-125.
[3] Chen W，Zheng R，Baade PD，et al. Cancer Statistics in China，2015 [J]. CA Cancer J Clin，2016，66（2）：115-132.
[4] Li X，Zheng R，Li X，et al. Trends of incidence rate and age at diagnosis for cervical cancer in China，from 2000 to 2014 [J]. Chin J Cancer Res，2017，29（6）：477-486.
[5] Xia C，Ding C，Zheng R，et al. Trends in geographical disparities for cervical cancer mortality in China from 1973 to 2013：a subnational spatio-temporal study [J]. Chin J Cancer Res，2017，29（6）：487-495.
[6] 卫生部、全国妇联关于印发《农村妇女“两癌”检查项目管理方案》的通知[EB/OL].http：//www.nhc.gov.cn/fys/s3581/200906/cd3c33a7ad624a50b8100b262041dabe.shtml
[7] Zhao F，Qiao Y. Cervical cancer prevention in China：a key to cancer control [J]. Lancet，2019，393（10175）：969-970.
[8] 赵方辉，陈俊峰，高晓虹，等.子宫颈癌筛查及早诊早治方案的绩效和卫生经济学评价[J].中华肿瘤杂志，2012， 34（8）：632-636.
[9] Shi JF，Canfell K，Lew JB，et al. Evaluation of primary HPV-DNA testing in relation to visual inspection methods for cervical cancer screening in rural China：an epidemiologic and cost-effectiveness modelling study [J]. BMC Cancer，2011，6（11）：239.
[10] Mezei AK，Armstrong HL，Pedersen HN，et al. Cost-effectiveness of cervical cancer screening methods in low- and middle-income countries：A systematic review [J] .Int J Cancer，2017，141（3）：437-446.
[11] Liu YJ，Zhang Q，Hu SY，et al. Effect of Vaccination Age on Cost-Effectiveness of Human Papillomavirus Vaccination Against Cervical Cancer in China [J]. BMC Cancer，2016，16（7）：A724-A735.
[12] Qiao YL，Sellors JW，Eder PS，et al. A new HPV-DNA test for cervical-cancer screening in developing regions：a cross-sectional study of clinical accuracy in rural China [J]. Lancet Oncol，2008，9（10）：929-936.
[13] 赵宇倩，戴毅，党乐，等.适合中国人群的宫颈癌筛查技术和效果评价的真实世界研究[J].中华肿瘤杂志，2018， 40（10）：764-771.
[14] Kaplan RS，Anderson SR. Time-driven activity-based costing：A simpler and more powerful path to higher profits [J]. Eur Acct Rev，2007，16（4）：855-861.
[15] 宋喜国，姚丽平，王海，等.基于TDABC法的医疗服务项目成本测算模型[J].中国卫生经济，2015，34（9）：82-84.
[16] Ronco G，Dillner J，Elfstr?觟m KM，et al. Efficacy of HPV-based screening for prevention of invasive cervical cancer：follow-up of four European randomised controlled trials [J]. Lancet，2014，383（9916）：524-532.
[17] Ogilvie GS，Krajden M，Van Niekerk DJ，et al. Primary cervical cancer screening with HPV testing compared with liquid-based cytology：results of round 1 of a randomised controlled trial：the HPV FOCAL Study [J]. Br J Cancer，2012，107（12）：1917-1924.
[18] Strander B，Andersson-Ellstr?觟m A，Milsom I，et al. Liquid-basedcytology versus conventional Papanicolaou smear in an organized screening program [J]. Cancer，2007，111（5）：285-291.
[19] Cheung AN，Szeto EF，Leung BS，et al. Liquid-based cytology and conventional cervical smears [J]. Cancer，2003，99（6）：331-335.
[20] Zhao FH，Zhang WH，Pan QJ，et al. A Study of cervical cancer screening algorithms [J]. Chin J Oncol，2010，32（6）：420-424.
[21] Qiao L，Li B，Long M，et al. Accuracy of visual inspection with acetic acid and with Lugol′s iodine for cervical cancer screening：Meta-analysis [J]. J Obstet Gynaecol Res，2015，41（9）：1313-1325.
2019, Vol. 16 
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