To identify the optimal cost-effective strategy for cervical cancer screening program in Thailand by comparing the different algorithms which based on the use of primary human papilloma virus (HPV) assay. We use a Microsoft Excel-based spreadsheet to calculate the accumulated cases of preinvasive and invasive cervical cancer and the budget impact of each screening program. The model was developed to determine the cost-effectiveness of 3 screening strategies: pooled HPV test with reflex liquid-based cytology triage, HPV genotyping with reflex p16/ki67 dual stain cytology, and pooled HPV test with dual stain. The main outcomes were the total cost, incremental quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). Strategy entailing primary HPV genotyping and reflex dual stain cytology is the least costly strategy (total cost US$37 893 407) and provides the similar QALY gained compared to pooled high-risk HPV testing with reflex dual stain (Average QALY 24.03). Pooled HPV test with reflex dual staining is more costly compared to strategy without reflex dual staining. The ICER was US$353.40 per QALY gained. One-way sensitivity analysis showed that the model is sensitive to the cost of dual stain and the cost of cancer treatment. Decreasing the incidence of cervical cancer case and increasing the QALYs can be successful by using dual stain cytology as the triage test for pooled HPV test or HPV genotyping. The result of our analysis favors the use of HPV genotyping with the reflex dual stain as it offers the most QALY at the lowest cost.

中文翻译：

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宫颈癌的主要HPV筛查策略和细胞学或双重染色分流的成本效果。

通过比较基于原发性人乳头瘤病毒（HPV）检测方法的不同算法，来确定泰国宫颈癌筛查计划的最佳成本效益策略。我们使用基于Microsoft Excel的电子表格来计算浸润前和浸润性宫颈癌的累积病例以及每个筛查计划的预算影响。该模型的开发是为了确定三种筛查策略的成本效益：采用基于反射液体的细胞学分类进行合并的HPV测试，采用反射p16 / ki67双色细胞学进行HPV基因分型以及使用双色合并HPV测试。主要结果是总成本，增加的质量调整生命年（QALY）和增加的成本效益比（ICER）。进行原发性HPV基因分型和反射双色细胞学检查的策略是成本最低的策略（总成本为37 893 407美元），与采用反射双色合并高风险HPV检测（平均QALY 24.03）相比，可提供相似的QALY。与没有反射双重染色的策略相比，具有反射双重染色的合并式HPV测试成本更高。每获得的QALY，ICER为353.40美元。单向敏感性分析表明，该模型对双重染色的成本和癌症治疗的成本敏感。通过使用双重染色细胞学作为合并的HPV检测或HPV基因分型的分类检测，可以成功降低宫颈癌病例的发生率并提高QALYs。我们的分析结果支持将HPV基因型与反射双重染色法一起使用，因为它以最低的成本提供了最多的QALY。