分子检测用于宫颈癌筛查的分流:使用余量分析的经济评估

Molecular Testing as Triage in Cervical Cancer Screening: Economic Evaluation Using Headroom Analysis.

作者信息

Castañeda Kelly M, Vermeulen Karin M, van Asselt Antoinette D I, Schuuring Ed, Wisman G Bea A, Greuter Marcel J W, de Bock Geertruida H

机构信息

Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands.

Department of Health Sciences, University Medical Centre Groningen, University of Groningen, 9700 RB Groningen, The Netherlands.

出版信息

Cancers (Basel). 2025 Feb 11;17(4):612. doi: 10.3390/cancers17040612.

Abstract

Molecular triage testing for high-risk human papillomavirus (hrHPV)-based cervical cancer screening can be used in self-sampling, potentially reducing unnecessary colposcopies and increasing attendance. However, its commercial value remains underexplored. This study used headroom analysis to estimate the maximum reimbursable price (MRP) at which molecular testing would be cost-effective for the triage of hrHPV-positive women, compared with cytology. A validated microsimulation Markov model for the Dutch cervical cancer screening program evaluated three triage scenarios: (1) cytology (base scenario), (2) molecular testing in self-samples only (scenario I), and (3) molecular testing on self- and GP-collected samples (scenario II). Test sensitivity and specificity ranged from 65% to 95%, with a threshold of EUR 20,000 per life-year gained. : In scenario I, MRPs ranged from EUR 244 (85% sensitivity, 75% specificity) to EUR 435 (95% sensitivity, 95% specificity). In scenario II, molecular testing was cost-effective across all parameters, with MRPs from EUR 162 (65% sensitivity, 65% specificity) to EUR 624 (95% sensitivity, 95% specificity). Increasing the sensitivity did not significantly affect life-years gained (due to the low mortality of cervical cancer in the Netherlands), but increased specificity did reduce the number of unnecessary colposcopies. : Enhancing the specificity of molecular triage testing will improve its commercial value by reducing colposcopy referrals without affecting the number of life-years gained.

摘要

基于高危型人乳头瘤病毒(hrHPV)的分子分流检测可用于宫颈癌筛查的自我采样,这有可能减少不必要的阴道镜检查并提高筛查参与率。然而,其商业价值仍未得到充分探索。本研究采用净空分析来估计分子检测相对于细胞学检查对hrHPV阳性女性进行分流时具有成本效益的最高可报销价格(MRP)。一个经过验证的荷兰宫颈癌筛查项目微观模拟马尔可夫模型评估了三种分流方案:(1)细胞学检查(基础方案),(2)仅对自我采样进行分子检测(方案I),以及(3)对自我采样和全科医生采集的样本进行分子检测(方案II)。检测灵敏度和特异性范围为65%至95%,每获得一个生命年的阈值为20,000欧元。在方案I中,MRP范围从244欧元(灵敏度85%,特异性75%)到435欧元(灵敏度95%,特异性95%)。在方案II中,分子检测在所有参数下均具有成本效益,MRP从162欧元(灵敏度65%,特异性65%)到624欧元(灵敏度95%,特异性95%)。提高灵敏度对获得的生命年数没有显著影响(由于荷兰宫颈癌死亡率较低),但提高特异性确实减少了不必要的阴道镜检查次数。提高分子分流检测的特异性将通过减少阴道镜检查转诊次数而不影响获得的生命年数来提高其商业价值。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/84bd/11853484/9de12e791e81/cancers-17-00612-g001.jpg

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