Hutchinson M L, Berger B M, Farber F L
Department of Pathology and Laboratory Medicine, Woimen and Infants' Hospital of Rhode Island, Providence, USA.
Am J Manag Care. 2000 Jul;6(7):766-80.
To compare the available techniques for cervical cancer screening, including several new technologies, using actual program utilization patterns.
Longitudinal cohort model.
The model followed a cohort of 100,000 women who underwent screening from age 20 through 65 years. The model was run with a weighted average of screening intervals to model the actual utilization of the cervical cancer screening program in the United States.
The model demonstrated that new technologies with significantly increased test sensitivity have the potential to reduce the number of cancers by 45% to 60% depending on the screening frequency in fully compliant populations. At screening intervals of 2 years or more, these new technologies had cost-effectiveness ratios below $50,000 per life-year saved. Assuming existing utilization patterns, the model predicted there would be 13.2 cancers per year in the 100,000 women screened with the conventional Pap smear, and new technologies with increased test sensitivity could reduce the annual incidence to 9.5 cancers per 100,000 women screened.
The model suggests that to achieve further dramatic reduction in cervical cancer mortality, significant improvements in test sensitivity, as reflected in the new screening technologies, may be the most realistic and cost-effective approach.
利用实际项目使用模式，比较宫颈癌筛查的现有技术，包括几种新技术。
纵向队列模型。
该模型追踪了10万名20至65岁接受筛查的女性队列。该模型以筛查间隔的加权平均值运行，以模拟美国宫颈癌筛查项目的实际使用情况。
该模型表明，在完全依从人群中，检测灵敏度显著提高的新技术有可能根据筛查频率将癌症数量减少45%至60%。在2年或更长时间的筛查间隔下，这些新技术的成本效益比低于每挽救一个生命年50,000美元。假设现有使用模式，该模型预测，在10万名接受传统巴氏涂片筛查的女性中，每年会有13.2例癌症，而检测灵敏度提高的新技术可将每10万名接受筛查女性的年发病率降至9.5例癌症。
该模型表明，要实现宫颈癌死亡率的进一步大幅降低，新筛查技术所反映的检测灵敏度的显著提高可能是最现实且最具成本效益的方法。
