Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway.
Department of Clinical Pathology, University Hospital of North Norway, Tromsø, Norway.
BJOG. 2017 Feb;124(3):474-484. doi: 10.1111/1471-0528.14135. Epub 2016 Jun 6.
To evaluate the short-term consequences and cost-effectiveness associated with the use of novel biomarkers to triage young adult women with minor cervical cytological lesions.
Model-based economic evaluation using primary epidemiological data from Norway, supplemented with data from European and American clinical trials.
Organised cervical cancer screening in Norway.
Women aged 25-33 years with minor cervical cytological lesions detected at their primary screening test.
We expanded an existing simulation model to compare 12 triage strategies involving alternative biomarkers (i.e. reflex human papillomavirus (HPV) DNA/mRNA testing, genotyping, and dual staining) with the current Norwegian triage guidelines.
The number of high-grade precancers detected and resource use (e.g. monetary costs and colposcopy referrals) for a single screening round (3 years) for each triage strategy. Cost-efficiency, defined as the additional cost per additional precancer detected of each strategy compared with the next most costly strategy.
Five strategies were identified as cost-efficient, and are projected to increase the precancer detection rate between 18 and 57%, compared with current guidelines; however, the strategies did not uniformly require additional resources. Strategies involving HPV mRNA testing required fewer resources, whereas HPV DNA-based strategies detected >50% more precancers, but were more costly and required twice as many colposcopy referrals compared with the current guidelines.
Strategies involving biomarkers to triage younger women with minor cervical cytological lesions have the potential to detect additional precancers, yet the optimal strategy depends on the resources available as well as decision-makers' and women's acceptance of additional screening procedures.
Women with minor cervical lesions may be triaged more accurately and effectively using novel biomarkers.
评估使用新型生物标志物对年轻成年女性轻度宫颈细胞学病变进行分流的短期后果和成本效益。
基于挪威原始流行病学数据并辅以欧洲和美国临床试验数据的模型为基础的经济评估。
挪威有组织的宫颈癌筛查。
在其初次筛查中发现轻度宫颈细胞学病变的 25-33 岁女性。
我们扩展了一个现有的模拟模型，以比较 12 种涉及替代生物标志物（即反射人乳头瘤病毒（HPV）DNA/mRNA 检测、基因分型和双重染色）的分流策略与当前挪威的分流指南。
对于每一种分流策略，在一个单独的筛查轮次（3 年）中，检测到的高级别癌前病变的数量以及资源的使用（例如货币成本和阴道镜转诊）。成本效益，定义为与下一个最昂贵的策略相比，每种策略每检测到一个额外癌前病变的额外成本。
确定了 5 种具有成本效益的策略，与当前指南相比，这些策略预计将使癌前病变的检出率提高 18%至 57%；然而，这些策略并没有统一地需要额外的资源。涉及 HPV mRNA 检测的策略需要更少的资源，而 HPV DNA 为基础的策略则检测到超过 50%的更多癌前病变，但成本更高，与当前指南相比，需要两倍的阴道镜转诊。
使用生物标志物对年轻女性轻度宫颈细胞学病变进行分流的策略有可能检测到更多的癌前病变，但最佳策略取决于可利用的资源以及决策者和女性对额外筛查程序的接受程度。
使用新型生物标志物对年轻女性轻度宫颈病变进行分流，可以更准确、更有效地进行。
