1 Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
2 King's College London, School of Cancer & Pharmaceutical Sciences, Cancer Prevention Group, Innovation Hub, Guys Cancer Centre, Guys Hospital, Great Maze Pond, London, UK.
J Med Screen. 2019 Mar;26(1):44-49. doi: 10.1177/0969141318800355. Epub 2018 Oct 3.
It often takes considerable time for sufficient evidence to accumulate to support implementation of new methods in routine screening. Where national screening programmes are already effective, switching to a more sensitive screening test may not be a priority. Although risk associated with overly rapid implementation exists, postponement is also associated with a (to date unquantified) missed opportunity to prevent deaths. This risk tends not to be addressed where effective screening methods are already in use. We here estimate the monetary value of a one-year delay in replacing cytology cervical screening with human papillomavirus testing.
Using a previously validated model, we calculated the number of incident and fatal cervical cancers that would be diagnosed by 2030 in England, under the assumption that human papillomavirus testing replaces cytology in 2020 rather than 2019, and the monetary value of the quality-adjusted life years lost in preventable cases.
A one-year delay in the implementation of human papillomavirus screening would miss the opportunity to prevent 581 cases of cervical cancer, and lead to a loss of 1595 quality-adjusted life years (3.5% discount rate) with a monetary value of £32 million (at £20,000 per quality-adjusted life year).
This is a measurable loss and should be considered in prioritising decision-making in screening.
在常规筛查中实施新方法需要相当长的时间才能积累足够的证据来支持。在已经有效的国家筛查计划中，切换到更敏感的筛查测试可能不是优先事项。虽然与过快实施相关的风险确实存在，但推迟也会错失迄今为止尚未量化的预防死亡的机会。在已经使用有效筛查方法的地方，这种风险往往没有得到解决。我们在这里估计用人类乳头状瘤病毒（HPV）检测替代细胞学宫颈筛查时，每年延迟一年所带来的货币价值。
我们使用先前经过验证的模型，计算了在英格兰，假设 HPV 检测在 2020 年而不是 2019 年替代细胞学检测，那么到 2030 年将诊断出多少例新的和致命的宫颈癌病例，以及在可预防病例中失去的质量调整生命年的货币价值。
HPV 筛查实施的一年延迟将错失预防 581 例宫颈癌的机会，并导致 1595 个质量调整生命年的损失（3.5%的贴现率），货币价值为 3200 万英镑（每个质量调整生命年 20000 英镑）。
这是一个可衡量的损失，在筛查的决策制定中应予以考虑。
