Goldie Sue J, Kim Jane J, Wright Thomas C
Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts 02115-5924, USA.
Obstet Gynecol. 2004 Apr;103(4):619-31. doi: 10.1097/01.AOG.0000120143.50098.c7.
To evaluate the cost-effectiveness of human papillomavirus (HPV) DNA testing as a primary screening test in combination with cervical cytology in women aged 30 years or more.
A state-transition mathematical model was used to simulate the natural history of HPV and cervical cancer in a cohort of U.S. women. Strategies included no screening and screening at different frequencies with conventional cytology, liquid-based cytology with HPV testing used for triage of equivocal results, and HPV DNA testing and cytology in combination after women had reached the age of 30. Outcomes measured included cancer incidence, life expectancy, lifetime costs, and incremental cost-effectiveness ratios.
The estimated reduction in lifetime risk of cervical cancer varies from 81% to 93% depending on the screening frequency, type of cytology, and test strategy. Every 3-year screening with liquid-based cytology administered to women at all ages and every 3-year screening using HPV DNA testing and cytology in combination administered to women aged 30 years or more provide equivalent or greater benefits than those provided by annual conventional cytology and have incremental cost-effectiveness ratios of US dollars 95300 and US dollars 228700 per year of life gained, respectively. In comparison, annual screening with HPV DNA testing and cytology in combination provides only a few hours of additional life expectancy and has a cost-effectiveness ratio of more than Us dollars 2000000 per year of life gained.
For women aged 30 years and more, every 2- or 3-year screening strategy that uses either HPV DNA testing in combination with cytology for primary screening or cytology with reflex HPV DNA testing for equivocal results will provide a greater reduction in cancer and be less costly than annual conventional cytology.
评估人乳头瘤病毒（HPV）DNA检测作为30岁及以上女性主要筛查检测并联合宫颈细胞学检查的成本效益。
采用状态转换数学模型模拟美国女性队列中HPV和宫颈癌的自然史。策略包括不进行筛查，以及采用不同频率进行常规细胞学检查、液基细胞学检查并使用HPV检测对意义不明确的结果进行分流、女性30岁后联合进行HPV DNA检测和细胞学检查。测量的结果包括癌症发病率、预期寿命、终身成本和增量成本效益比。
根据筛查频率、细胞学类型和检测策略，估计宫颈癌终身风险降低幅度在81%至93%之间。对所有年龄段女性每3年进行一次液基细胞学检查，以及对30岁及以上女性每3年联合进行HPV DNA检测和细胞学检查，与每年进行常规细胞学检查相比，提供了同等或更大的益处，每获得一年生命的增量成本效益比分别为95300美元和228700美元。相比之下，每年联合进行HPV DNA检测和细胞学检查仅能增加几个小时的预期寿命，每获得一年生命的成本效益比超过200万美元。
对于30岁及以上女性，每2年或3年采用HPV DNA检测联合细胞学检查进行初次筛查，或对意义不明确的结果采用细胞学检查并进行HPV DNA检测的筛查策略，将比每年进行常规细胞学检查能更大程度地降低癌症风险且成本更低。
