尽管由于有组织的细胞学筛查计划，高收入国家的宫颈癌发病率有所下降，但它仍然是东非妇女癌症死亡的主要原因。因此，世界卫生组织 (WHO) 现在敦促医疗服务提供者从广泛流行但性能低下的醋酸目视检查 (VIA) 筛查过渡到初级人乳头瘤病毒 (HPV) DNA 检测。由于 HPV 患病率较高，因此需要有效的分类测试来识别那些可能进展的病变，从而避免过度治疗。为了确定最佳的成本效益策略，我们将 VIA 筛查和治疗方法与 p16/Ki67 双染色细胞学或 VIA 作为分类的初级 HPV DNA 检测进行了比较。我们使用马尔可夫模型来计算每个策略的预算影响，以增量质量调整生命年和增量成本效益比 (ICER) 作为主要结果。确定性成本效益分析表明，筛查和治疗方法具有很高的成本效益 (ICER 2469 Int$)，而筛查、分类和双重染色治疗是最有效的，ICER 比 VIA 分类更有效 (ICER 9943 Int$ 与 13,177 Int$ 相比）。单向敏感性分析表明，结果对折扣、VIA 性能和测试价格最为敏感。在概率敏感性分析中，根据 WHO 标准，在愿意支付阈值 7115 Int$ 之上，使用双染色的分诊选项是具有成本效益的最佳选择。我们的分析结果倾向于使用双重染色而不是 VIA 作为 HPV 阳性女性的分诊，并预示着未来的机会和必要的研究，以提高宫颈癌筛查计划的覆盖范围和可接受性。© 2024 作者。约翰·威利出版的《国际癌症杂志》

While the incidence of cervical cancer has dropped in high-income countries due to organized cytology-based screening programs, it remains the leading cause of cancer death among women in Eastern Africa. Therefore, the World Health Organization (WHO) now urges providers to transition from widely prevalent but low-performance visual inspection with acetic acid (VIA) screening to primary human papillomavirus (HPV) DNA testing. Due to high HPV prevalence, effective triage tests are needed to identify those lesions likely to progress and so avoid over-treatment. To identify the optimal cost-effective strategy, we compared the VIA screen-and-treat approach to primary HPV DNA testing with p16/Ki67 dual-stain cytology or VIA as triage. We used a Markov model to calculate the budget impact of each strategy with incremental quality-adjusted life years and incremental cost-effectiveness ratios (ICER) as the main outcome. Deterministic cost-effectiveness analyses show that the screen-and-treat approach is highly cost-effective (ICER 2469 Int$), while screen, triage, and treat with dual staining is the most effective with favorable ICER than triage with VIA (ICER 9943 Int$ compared with 13,177 Int$). One-way sensitivity analyses show that the results are most sensitive to discounting, VIA performance, and test prices. In the probabilistic sensitivity analyses, the triage option using dual stain is the optimal choice above a willingness to pay threshold of 7115 Int$ being cost-effective as per WHO standards. The result of our analysis favors the use of dual staining over VIA as triage in HPV-positive women and portends future opportunities and necessary research to improve the coverage and acceptability of cervical cancer screening programs.© 2024 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.