Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Pathology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
Cancer Med. 2024 Oct;13(19):e70299. doi: 10.1002/cam4.70299.
Computer-assisted screening (CAS) shows equal performance compared to manual screening, although results are heterogeneous. Furthermore, using CAS may save costs through a potentially increased screening productivity of technicians, therefore also offering a solution for temporary and structural capacity shortage. We evaluated the circumstances under which CAS will be cost-effective compared to manual cytology triage in a primary HPV-based cervical screening programme.
Microsimulation model MISCAN-Cervix was used to evaluate 198 different CAS scenarios with varying probabilities to detect cervical intraepithelial neoplasia grade 1 (CIN1) and CIN3 and cost reductions per test, compared to manual cytology triage. Cost-effectiveness was evaluated by costs per (quality-adjusted) life year ((QA)LY) gained.
CAS will be cost-effective in all scenarios, except for the following combinations: (1) no cost reduction and an increased probability of detecting CIN1, (2) a cost reduction of €2 per test and an increased probability of detecting CIN1 from 4% onwards or (3) a cost reduction of €4 per test and an increased probability of detecting CIN1 from 6% onwards, compared to manual cytology triage. All CAS scenarios with any reduction in the probability of detecting CIN1 (i.e., increased CIN2+ specificity), or a reduction in costs from €6 per test onwards suggested a more cost-effective strategy compared to manual cytology triage.
As we based our analysis on a realistic range in costs and test performance, the implementation of CAS is likely to be cost-effective. Our results can be used as a guideline to advise when to choose CAS instead of manual cytology triage.
计算机辅助筛查 (CAS) 的表现与手动筛查相当，尽管结果存在异质性。此外，通过提高技师的筛查效率，使用 CAS 还可能节省成本，因此也为暂时和结构性的资源短缺提供了一种解决方案。我们评估了在基于 HPV 的初级宫颈癌筛查项目中，与手动细胞学分流相比，CAS 在何种情况下具有成本效益。
使用 Microsimulation model MISCAN-Cervix 评估了 198 种不同的 CAS 场景，这些场景的检测宫颈癌前病变 1 级（CIN1）和 CIN3 的概率以及每个测试的成本降低幅度有所不同，与手动细胞学分流相比。通过每（质量调整）生命年 (QALY) 的成本效益进行评估。
除了以下几种组合之外，CAS 在所有场景下都具有成本效益：（1）无成本降低且检测 CIN1 的概率增加；（2）每个测试的成本降低 2 欧元且检测 CIN1 的概率从 4%起增加；（3）每个测试的成本降低 4 欧元且检测 CIN1 的概率从 6%起增加，与手动细胞学分流相比。与手动细胞学分流相比，所有降低检测 CIN1 概率（即增加 CIN2+特异性）的 CAS 场景，或成本降低从每个测试 6 欧元起，都表明这是一种更具成本效益的策略。
由于我们的分析基于成本和测试性能的现实范围，因此实施 CAS 很可能具有成本效益。我们的研究结果可作为指导，帮助决策者在选择 CAS 还是手动细胞学分流时做出决策。
