McKesson Corp., San Francisco, CA, USA.
Can J Public Health. 2010 May-Jun;101(3):220-5. doi: 10.1007/BF03404377.
Human papillomavirus (HPV) testing is not widely used for triage of equivocal Pap smears or primary screening in Québec, Canada. Our objective was to evaluate the cost-effectiveness of cervical cancer screening strategies utilizing HPV testing.
We used a lifetime Markov model to estimate costs, quality of life, and survival associated with the following strategies: 1) cytology; 2) cytology with HPV testing to triage equivocal Pap smears; 3) HPV testing followed by colposcopy for HPV-positive women; 4) HPV testing with cytology to triage HPV-positive women; and 5) simultaneous HPV testing and cytology. Cytology was used in all strategies prior to age 30. Outcome measures included disease incidence, quality-adjusted life-years saved (QALYs), lifetime risk of cervical cancer, and incremental cost-effectiveness ratios.
All strategies incorporating HPV testing as a primary screening test were more effective and less expensive than annual cytology alone, while HPV testing to triage equivocal Pap smears annually was very cost-effective ($2,991 per QALY gained compared to annual cytology alone). When compared to cytology every three years, HPV-based strategies cost an additional $8,200 to $13,400 per QALY gained.
Strategies incorporating HPV testing are not only more effective than screening based on cytology alone but are also highly cost-effective. Provincial policy-makers should evaluate incorporating HPV-based strategies into current cervical cancer screening guidelines.
人乳头瘤病毒（HPV）检测并未在加拿大魁北克省广泛用于对不明确的巴氏涂片或初级筛查进行分流。我们的目的是评估利用 HPV 检测进行宫颈癌筛查策略的成本效益。
我们使用终生马尔可夫模型来估计与以下策略相关的成本、生活质量和生存：1）细胞学；2）细胞学联合 HPV 检测对不明确的巴氏涂片进行分流；3）HPV 检测阳性的女性行阴道镜检查；4）HPV 检测联合细胞学对 HPV 检测阳性的女性进行分流；5）HPV 检测联合细胞学同时进行。细胞学在所有策略中均在 30 岁之前使用。结局指标包括疾病发病率、质量调整生命年（QALYs）节省、宫颈癌终生风险和增量成本效益比。
所有纳入 HPV 检测作为初级筛查检测的策略均比单独每年进行细胞学检查更有效且更经济，而每年对不明确的巴氏涂片进行 HPV 检测则非常具有成本效益（与单独每年进行细胞学检查相比，每 QALY 节省 2991 美元）。与每三年进行细胞学检查相比，基于 HPV 的策略每获得一个 QALY 需额外增加 8200 至 13400 美元的成本。
纳入 HPV 检测的策略不仅比单独基于细胞学的筛查更有效，而且具有很高的成本效益。省级政策制定者应评估将基于 HPV 的策略纳入当前的宫颈癌筛查指南。
