Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands.
Int J Cancer. 2010 Nov 1;127(9):2147-58. doi: 10.1002/ijc.25211.
We studied the health and economic effects of human papillomavirus (HPV) DNA testing in cervical screening using a simulation model. The key data source was a Dutch longitudinal screening trial. We compared cytological testing with repeat cytology (for borderline/mildly abnormal smears) to HPV testing with cytology triage (for HPV-positive smears), combination testing (combined HPV and cytology) and cytological testing with HPV triage (for borderline/mildly abnormal smears). We varied the screening interval from 5 to 10 years. The main outcome measures were the number of cervical cancer cases, the number of quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER). The base-case estimates were accompanied with ranges across 118 calibrated parameter settings (calibration criteria: cervical intraepithelial neoplasia 2/3, cancer and mortality rates). In comparison to 5-yearly cytology, 5-yearly HPV testing with cytology triage gave a reduction in the number of cancer cases of 23% (range, 9-27%). The reduction was 26% (range, 10-29%) for combination testing and 3% (range, -1 to 8%) for cytology with HPV triage. For strategies with primary HPV testing, the model also estimated a reduction in cancer cases when the screening interval was extended to 7.5 years. Five-yearly cytology with HPV triage and 5 to 7.5-yearly HPV testing with cytology triage were cost effective for the base-case settings and the majority of calibrated parameter settings (ICER below Dutch willingness-to-pay threshold of euro20,000/QALY). Our model indicates that HPV testing with cytology triage is likely to be cost effective. An extension of the screening interval may be considered to control costs.
我们使用模拟模型研究了人乳头瘤病毒（HPV）DNA 检测在宫颈癌筛查中的健康和经济影响。关键数据来源是荷兰一项纵向筛查试验。我们比较了细胞学检测与重复细胞学（用于边界/轻度异常涂片）、HPV 检测与细胞学分流（用于 HPV 阳性涂片）、联合检测（HPV 和细胞学联合检测）和细胞学检测与 HPV 分流（用于边界/轻度异常涂片）。我们将筛查间隔从 5 年延长至 10 年。主要结果指标是宫颈癌病例数、质量调整生命年（QALY）数和增量成本效益比（ICER）。基本情况估计伴随着 118 个校准参数设置的范围（校准标准：宫颈上皮内瘤变 2/3、癌症和死亡率）。与 5 年细胞学相比，5 年 HPV 检测与细胞学分流可减少 23%的宫颈癌病例数（范围为 9-27%）。联合检测减少了 26%（范围为 10-29%），细胞学联合 HPV 分流减少了 3%（范围为-1 至 8%）。对于以初级 HPV 检测为基础的策略，当筛查间隔延长至 7.5 年时，该模型还估计会减少癌症病例。对于基本情况设置和大多数校准参数设置（ICER 低于荷兰 20000 欧元/QALY 的意愿支付阈值），5 年细胞学联合 HPV 分流和 5 至 7.5 年 HPV 检测与细胞学分流具有成本效益。我们的模型表明，HPV 检测与细胞学分流可能具有成本效益。可以考虑延长筛查间隔以控制成本。
