Purpose: To systematically review published cost-effectiveness analyses of Evidence-Based Interventions (EBIs) recommended by the United States Community Preventive Services Task Force (CPSTF) to increase breast and cervical cancer screening. Methods: We searched PubMed and Embase for prospective cost-effectiveness evaluations of EBIs for breast and cervical cancer screening since 1999. We reviewed studies according to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) and compared the incremental cost-effectiveness ratio (ICERs), defined as cost per additional woman screened, adjusted to 2021 USD, within and across EBIs by cancer type. Results: We identified eleven studies meeting our review criteria: nine were breast cancer-focused, one breast and cervical cancer combined, and one cervical only, which together reported twenty-four cost-effectiveness assessments of outreach programs spanning eight EBIs. One-on-one education programs were the most common EBI evaluated. The average ICER across breast cancer studies was USD 545 (standard deviation [SD] = USD 729.3), while that for cervical cancer studies was USD 197 (SD = 186.6. Provider reminder/recall systems for women already linked to formal care were the most cost-effective, with an average ICERs of USD 41.3 and USD 10.6 for breast and cervical cancer, respectively. Conclusions: Variability in ICERs across and within EBIs reflect the population studied, the specific EBI, and study settings, and was relatively high. ICER estimate uncertainty and the potential for program replicability in other settings and with other populations were not addressed. Given these limitations, using existing cost-effectiveness estimates to inform program funding allocations is not warranted at this time. Additional research is needed on outreach programs for cervical cancer and those which serve minority populations for either of the female cancer screens.
目的：系统综述美国社区预防服务工作组推荐的循证干预措施在提高乳腺癌和宫颈癌筛查率方面的成本效益分析文献。方法：检索1999年以来PubMed和Embase数据库中关于乳腺癌和宫颈癌筛查循证干预措施的前瞻性成本效益评估研究。依据《卫生经济评价报告标准统一声明》对纳入文献进行审查，按癌症类型比较不同干预措施内部及之间的增量成本效益比（定义为每增加一名筛查女性所需成本，统一折算为2021年美元价值）。结果：共纳入11项符合标准的研究：9项聚焦乳腺癌，1项涵盖乳腺癌与宫颈癌，1项仅针对宫颈癌，合计报告了8类循证干预措施中24项外展项目的成本效益评估。一对一教育项目是最常见的评估类型。乳腺癌研究的平均增量成本效益比为545美元（标准差=729.3美元），宫颈癌研究为197美元（标准差=186.6美元）。针对已建立正规医疗联系女性的医疗提供者提醒/召回系统最具成本效益，其乳腺癌和宫颈癌筛查的平均增量成本效益比分别为41.3美元和10.6美元。结论：不同循证干预措施之间及内部的增量成本效益比差异较大，这反映了研究人群、具体干预措施及研究环境的异质性。现有研究未涉及增量成本效益比估计的不确定性，也未探讨在其他环境和人群中的项目可复制性。鉴于这些局限性，目前尚不能依据现有成本效益评估结果指导项目资金分配。未来需加强对宫颈癌筛查外展项目及服务于少数族裔群体的两类妇科癌症筛查项目的成本效益研究。
肿瘤(癌症)患者之家