Abstract：
Female genital schistosomiasis is a chronic gynaecological disease caused by the waterborne parasite Schistosoma (S.) haematobium. It affects an estimated 30-56 million girls and women globally, mostly in sub-Saharan Africa where it is endemic, and negatively impacts their sexual and reproductive life. Recent studies found evidence of an association between female genital schistosomiasis and increased prevalence of HIV and cervical precancer lesions. Despite the large population at risk, the burden and impact of female genital schistosomiasis are scarcely documented, resulting in neglect and insufficient resource allocation. There is currently no standardised method for individual or population-based female genital schistosomiasis screening and diagnosis which hinders accurate assessment of disease burden in endemic countries. To optimise financial allocations for female genital schistosomiasis screening, it is necessary to explore the cost-effectiveness of different strategies by combining cost and impact estimates. Yet, no economic evaluation has explored the value for money of alternative screening methods. This paper describes a novel application of health decision analytical modelling to evaluate the cost-effectiveness of different female genital schistosomiasis screening strategies across endemic settings. The model combines a decision tree for female genital schistosomiasis screening strategies, and a Markov model for the natural history of cervical cancer to estimate the cost per disability-adjusted life-years averted for different screening strategies, stratified by HIV status. It is a starting point for discussion and for supporting priority setting in a data-sparse environment.
摘要：
女性生殖器血吸虫病是由水传播的寄生虫血吸虫引起的慢性妇科疾病（S.)血吸虫。它影响到全球约3000万至5600万女孩和妇女，大部分在撒哈拉沙漠以南的非洲，并对他们的性生活和生殖生活产生负面影响。最近的研究发现，女性生殖器血吸虫病与HIV患病率增加和宫颈癌前病变之间存在关联。尽管有大量人口处于危险之中，女性生殖器血吸虫病的负担和影响几乎没有记载，导致忽视和资源分配不足。目前还没有针对基于个体或人群的女性生殖器血吸虫病筛查和诊断的标准化方法，这阻碍了对流行国家疾病负担的准确评估。优化女性生殖器血吸虫病筛查的财政拨款，有必要通过结合成本和影响估计来探索不同策略的成本效益。然而，没有经济评估探索替代筛查方法的价值。本文介绍了健康决策分析模型的新应用，以评估不同流行环境中不同女性生殖器血吸虫病筛查策略的成本效益。该模型结合了女性生殖器血吸虫病筛查策略的决策树，和一个用于宫颈癌自然史的马尔可夫模型，以估计不同筛查策略避免的每个残疾调整生命年的成本，按艾滋病毒状况分层。它是讨论和支持数据稀疏环境中优先级设置的起点。
