Simple but not simpler: a systematic review of Markov models for economic evaluation of cervical cancer screening

Author(s)

Juliana Yukari Kodaira Viscondi ^[1] ; Christine Grutzmann Faustino ^[1] ; Alessandro Gonçalves Campolina ^[3] ; Alexander Itria ^[3] ; Patricia Coelho de Soárez ^[5]

Affiliation

^[1] Univ Sao Paulo, Fac Med FMUSP, Dept Med Prevent, Sao Paulo, SP - Brazil

^[2] Universidade de Sao Paulo. Hospital das Clinicas HCFMUSP, Faculdade de Medicina. Instituto do Cancer do Estado de Sao Paulo (ICESP) - Brasil

^[3] Univ Fed Goias, Inst Patol Trop & Saude Publ, Dept Saude Colet Nucleo Econ & Avaliacoes Saude, Inst Avaliacao Tecnol Saude, Goias, Go - Brazil

^[4] Universidade de Sao Paulo. Faculdade de Medicina FMUSP. Departamento de Medicina Preventiva - Brasil

• Document type: Journal article
• Source: Clinics; v. 73, 2018-07-10.

Abstract

The aim of this study was to critically evaluate the quality of the models used in economic evaluations of screening strategies for cervical cancer prevention. We systematically searched multiple databases, selecting model-based full economic evaluations (cost-effectiveness analyses, cost-utility analyses, and cost-benefit analyses) of cervical cancer screening strategies. Two independent reviewers screened articles for relevance and performed data extraction. Methodological assessment of the quality of the models utilized formal checklists, and a qualitative narrative synthesis was performed. Thirty-eight articles were reviewed. The majority of the studies were conducted in high-income countries (82%, n=31). The Pap test was the most used screening strategy investigated, which was present in 86% (n=33) of the studies. Half of the studies (n=19) used a previously published Markov model. The deterministic sensitivity analysis was performed in 92% (n=35) of the studies. The mean number of properly reported checklist items was 9 out of the maximum possible 18. Items that were better reported included the statement of decision problem, the description of the strategies/comparators, the statement of time horizon, and information regarding the disease states. Compliance with some items of the checklist was poor. The Markov models for economic evaluation of screening strategies for cervical cancer varied in quality. The following points require improvement: 1) assessment of methodological, structural, heterogeneity, and parameter uncertainties; 2) model type and cycle length justification; 3) methods to account for heterogeneity; and 4) report of consistency evaluation (through calibration and validation methods). (AU)

• FAPESP's process: 14/50042-4 - Cost-effectiveness analysis of cervical cancer screening strategies in Brazil
• Grantee: Patricia Coelho de Soárez
• Support Opportunities: Research Grants - Research in Public Policies for the National Health Care System (PP-SUS)