| Autor: |
Nicole G, Campos, Naomi, Lince-Deroche, Carla J, Chibwesha, Cynthia, Firnhaber, Jennifer S, Smith, Pam, Michelow, Gesine, Meyer-Rath, Lise, Jamieson, Suzette, Jordaan, Monisha, Sharma, Catherine, Regan, Stephen, Sy, Gui, Liu, Vivien, Tsu, Jose, Jeronimo, Jane J, Kim |
| Rok vydání: |
2018 |
| Předmět: |
|
| Zdroj: |
Journal of acquired immune deficiency syndromes (1999). 79(2) |
| ISSN: |
1944-7884 |
| Popis: |
Women with HIV face an increased risk of human papillomavirus (HPV) acquisition and persistence, cervical intraepithelial neoplasia, and invasive cervical cancer. Our objective was to determine the cost-effectiveness of different cervical cancer screening strategies among women with HIV in South Africa.We modified a mathematical model of HPV infection and cervical disease to reflect coinfection with HIV. The model was calibrated to epidemiologic data from HIV-infected women in South Africa. Clinical and economic data were drawn from in-country data sources. The model was used to project reductions in the lifetime risk of cervical cancer and incremental cost-effectiveness ratios (ICERs) of Pap and HPV DNA screening and management algorithms beginning at HIV diagnosis, at 1-, 2-, or 3-year intervals. Strategies with an ICER below South Africa's 2016 per capita gross domestic product (US$5270) were considered "cost-effective."HPV testing followed by treatment (test-and-treat) at 2-year intervals was the most effective strategy that was also cost-effective, reducing lifetime cancer risk by 56.6% with an ICER of US$3010 per year of life saved. Other cost-effective strategies included Pap (referral threshold: HSIL+) at 1-, 2-, and 3-year intervals, and HPV test-and-treat at 3-year intervals. Pap (ASCUS+), HPV testing with 16/18 genotyping, and HPV testing with Pap or visual triage of HPV-positive women were less effective and more costly than alternatives.Considering per capita gross domestic product as the benchmark for cost-effectiveness, HPV test-and-treat is optimal in South Africa. At lower cost-effectiveness benchmarks, Pap (HSIL+) would be optimal. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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