Howard Kirsten, Salkeld Glenn, McCaffery Kirsten, Irwig Les
Screening and Test Evaluation Program, School of Public Health, University of Sydney, Sydney, NSW, Australia.
Health Econ. 2008 May;17(5):593-605. doi: 10.1002/hec.1278.
A two-stage standard gamble was used to evaluate women's preferences for alternative managements of atypical squamous cells of undermined significance (ASCUS) on Pap smear (repeat Pap smear compared with immediate HPV test), and to test for the evidence of process utility. Women's utilities for the health state scenarios were clustered towards the upper end of the 0-1 scale with considerable variability in women's preferences. There was evidence of process utility, with immediate human papillomavirus (HPV) testing strategies having lower valuations than repeat Pap smear, where the clinical outcome was the same. Mean (95% CI) utilities for HPV testing (negative test) followed by resolution were 0.9967 (0.9957-0.9978) compared with repeat Pap smear followed by resolution: 0.9972 (0.9964-0.9980). Mean (95% CI) utilities for immediate HPV testing (positive test), followed by colposcopy, biopsy and treatment were 0.9354 (0.8544-1.0) compared with repeat Pap smear followed by colposcopy, biopsy and treatment: 0.9656 (0.9081-1.0). Our results add to the existing evidence that the impact of healthcare interventions on well-being is not limited to the effect of the intervention on the health outcomes expected from the intervention; process of care can have quality of life implications for the individual. A modelled application of trial-based data will allow characterisation of the true population costs, benefits, risks and harms of alternative triage strategies and subsequent policy implications thereof.
采用两阶段标准博弈法评估女性对于巴氏涂片检查中意义不明确的非典型鳞状细胞（ASCUS）的不同处理方式（重复巴氏涂片与立即进行人乳头瘤病毒（HPV）检测）的偏好，并检验过程效用的证据。女性对健康状态情景的效用值集中在0至1量表的上端，女性偏好存在相当大的差异。有证据表明存在过程效用，在临床结果相同的情况下，立即进行HPV检测策略的估值低于重复巴氏涂片。HPV检测（检测结果为阴性）随后病情缓解的平均（95%可信区间）效用值为0.9967（0.9957 - 0.9978），而重复巴氏涂片随后病情缓解的平均（95%可信区间）效用值为0.9972（0.9964 - 0.9980）。立即进行HPV检测（检测结果为阳性），随后进行阴道镜检查、活检和治疗的平均（95%可信区间）效用值为0.9354（0.8544 - 1.0），而重复巴氏涂片随后进行阴道镜检查、活检和治疗的平均（95%可信区间）效用值为0.9656（0.9081 - 1.0）。我们的结果进一步证明，医疗保健干预对幸福感的影响不仅限于干预对预期健康结果的作用；护理过程可能对个体生活质量产生影响。基于试验数据的模型应用将有助于描述不同分诊策略的真实总体成本、效益、风险和危害及其后续政策影响。
