自取样HPV检测和热消融是增加筛查率和治疗依从性的有效工具，加速子宫颈癌消除。我们评估了它们的联合策略的成本效益，旨在为人们提供可接受、经济实惠且易于得到的子宫颈癌预防策略。我们制定了混合模型，从社会角度评估了六种筛查和治疗策略的成本、健康结果和增量成本效益比（ICER），这六种策略结合了HPV检测（自取样或医师取样）、分流模式（HPV基因分类、阴道镜检查或无分流）和热消融。我们考虑了一个最初的出生于2015年的10万名女性的指定初期队列。ICER低于中国人均国内生产总值（GDP）（10,350美元）的策略被认为是高成本效益的。与中国当前策略（医师-HPV基因分类或细胞学分流）相比，所有筛查和治疗策略都是具有成本效益的，其中自行采集HPV而无需分流是最优的，在城乡地区均可获得最多的递增调整后寿命年数（QALY）（220到440）。与当前医师-HPV基因分类策略相比，基于自采样样本的每个筛查和治疗策略都可以节约成本（-81,8430至-3540美元），而与当前策略相比，更多的费用将用于处理癌前病变而不是癌症治疗。然而，需要注意的是，超过81.6%的HPV阳性女性将被过度治疗。如果用HPV 7型或HPV16/18基因型进行分类，79.1%或67.2%的HPV阳性女性将被过度治疗，癌症病例减少较少（19例或69例）。联合使用自取样HPV检测和热消融的筛查和治疗策略可能是中国子宫颈癌预防中最具有成本效益的。通过质保操作进行额外的分流，可以减少过度治疗，而且与当前策略相比，成本效益仍然很高。©2023年 。 作者。

Self-sampling HPV test and thermal ablation are effective tools to increase screening coverage and treatment compliance for accelerating cervical cancer elimination. We assessed the cost-effectiveness of their combined strategies to inform accessible, affordable, and acceptable cervical cancer prevention strategies.We developed a hybrid model to evaluate costs, health outcomes, and incremental cost-effectiveness ratios (ICER) of six screen-and-treat strategies combining HPV testing (self-sampling or physician-sampling), triage modalities (HPV genotyping, colposcopy or none) and thermal ablation, from a societal perspective. A designated initial cohort of 100,000 females born in 2015 was considered. Strategies with an ICER less than the Chinese gross domestic product (GDP) per capita ($10,350) were considered highly cost-effective.Compared with current strategies in China (physician-HPV with genotype or cytology triage), all screen-and-treat strategies are cost-effective and self-HPV without triage is optimal with the most incremental quality-adjusted life-years (QALYs) gained (220 to 440) in rural and urban China. Each screen-and-treat strategy based on self-collected samples is cost-saving compared with current strategies (-$818,430 to -$3540) whereas more costs are incurred using physician-collected samples compared with current physician-HPV with genotype triage (+$20,840 to +$182,840). For screen-and-treat strategies without triage, more costs (+$9404 to +$380,217) would be invested in the screening and treatment of precancerous lesions rather than the cancer treatment compared with the current screening strategies. Notably, however, more than 81.6% of HPV-positive women would be overtreated. If triaged with HPV 7 types or HPV16/18 genotypes, 79.1% or 67.2% (respectively) of HPV-positive women would be overtreated with fewer cancer cases avoided (19 cases or 69 cases).Screen-and-treat strategy using self-sampling HPV test linked to thermal ablation could be the most cost-effective for cervical cancer prevention in China. Additional triage with quality-assured performance could reduce overtreatment and remains highly cost-effective compared with current strategies.© 2023. The Author(s).