Bains Irenjeet, Choi Yoon Hong, Soldan Kate, Jit Mark
Modelling and Economics Unit, Public Health England, London, UK.
HIV & STI Department, Public Health England, London, UK.
Int J Gynecol Cancer. 2019 May 7;29(4):669-675. doi: 10.1136/ijgc-2018-000161.
In England, human papillomavirus (HPV) testing is to replace cytological screening by 2019-2020. We conducted a model-based economic evaluation to project the long-term clinical impact and cost-effectiveness of routine cytology versus HPV testing.
An individual-based model of HPV acquisition, natural history, and cervical cancer screening was used to compare cytological screening and HPV testing with cytology triage for women aged 25-64 years (with either 3- or 5-year screening intervals for women aged under 50 years). The model was fitted to data from England's National Health Service Cervical Screening Programme. Both clinical and economic outcomes were projected to inform cost-effectiveness analyses.
HPV testing is likely to decrease annual cytology testing (by 2.76 million), cervical cancer incidence (by 290 cases), and health system costs (by £13 million). It may increase the number of colposcopies, although this could be reduced without leading to more cancers compared with primary cytology by increasing the interval between screens to 5 years. The impact in terms of quality-adjusted life-years (QALYs) depends on the quality of life weight given to colposcopies versus cancer.
England's move from cytology to HPV screening may potentially be life-saving and cost-effective. Cost-effectiveness can be improved further by extending the interval between screens or using alternative triage methods such as partial or full genotyping.
在英国，到2019 - 2020年人乳头瘤病毒（HPV）检测将取代细胞学筛查。我们进行了一项基于模型的经济评估，以预测常规细胞学检查与HPV检测的长期临床影响和成本效益。
使用一个基于个体的HPV感染、自然史和宫颈癌筛查模型，比较25 - 64岁女性的细胞学筛查以及HPV检测加细胞学分流（50岁以下女性筛查间隔为3年或5年）。该模型与英国国家医疗服务体系宫颈癌筛查项目的数据相拟合。对临床和经济结果进行预测，以指导成本效益分析。
HPV检测可能会减少每年的细胞学检测次数（减少276万次）、宫颈癌发病率（减少290例）以及卫生系统成本（减少1300万英镑）。它可能会增加阴道镜检查的次数，不过，通过将筛查间隔延长至5年，与初次细胞学检查相比，在不导致更多癌症的情况下，这一情况可能会得到缓解。在质量调整生命年（QALY）方面的影响取决于赋予阴道镜检查与癌症的生活质量权重。
英国从细胞学筛查转向HPV筛查可能具有潜在的挽救生命和成本效益。通过延长筛查间隔或使用替代分流方法，如部分或全基因分型，可以进一步提高成本效益。
