Schevenhoven Veerle J C, Jansen Erik E L, de Kok Inge M C M
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3015GD Rotterdam, the Netherlands.
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3015GD Rotterdam, the Netherlands.
Prev Med. 2025 Aug;197:108329. doi: 10.1016/j.ypmed.2025.108329. Epub 2025 Jun 15.
In the Netherlands, women are currently invited for human papillomavirus (HPV) screening until age 60 (or age 65 for HPV-positive women). New data from HPV screening implementation in the Netherlands improved understanding of its longer-term protective effects and risk differences between population subgroups. With this, our aim was to optimize screening exit strategies.
The microsimulation model MISCAN-Cervix was used to simulate a population of unvaccinated women born between 1962 and 1992 over their lifetime. We simulated 20 different exit strategies, varying by screening end ages and screening interval dependent on previous HPV status, with two triage methods (cytology triage or direct colposcopy referral for HPV16/18+ women aged ≥60). Main outcome measures were total and unnecessary colposcopy referrals (i.e. ≤ cervical intra-epithelial neoplasia stage 1), cancer cases and deaths prevented, and (quality-adjusted) life years gained ((QA)LYG). The incremental cost-effectiveness ratios (ICERs) were calculated for scenarios on the cost-effectiveness frontier.
Screening of HPV-positive women at age 65 and age 70, with direct colposcopy referral of HPV16/18+ women aged ≥60 was the optimal exit strategy considering a threshold of €50,000 per LYG (ICER: €20,190/LYG, €46,985/QALY). This resulted in 18 additional cancer deaths prevented and 158 additional unnecessary referrals per 100,000 simulated women compared to the current strategy. Direct colposcopy referral of HPV16/18+ women aged ≥60 improved cost-effectiveness in all scenarios.
In the Dutch HPV screening program, adding screening moments for older HPV-positive women and/or incorporating direct referrals for HPV16/18+ women is cost-effective and could increase the efficiency and effectiveness of screening.
在荷兰，目前邀请女性进行人乳头瘤病毒（HPV）筛查至60岁（HPV检测呈阳性的女性至65岁）。荷兰HPV筛查实施的新数据增进了人们对其长期保护作用以及人群亚组之间风险差异的理解。据此，我们的目标是优化筛查退出策略。
使用微观模拟模型MISCAN - 子宫颈来模拟1962年至1992年出生的未接种疫苗女性一生的情况。我们模拟了20种不同的退出策略，筛查结束年龄和筛查间隔因先前的HPV状态而异，采用两种分流方法（细胞学分流或对60岁及以上HPV16/18阳性女性直接转诊至阴道镜检查）。主要结局指标为总的和不必要的阴道镜转诊（即≤宫颈上皮内瘤变1级）、预防的癌症病例和死亡人数以及获得的（质量调整）生命年（（QA）LYG）。计算成本效益前沿情景下的增量成本效益比（ICER）。
考虑到每获得一个质量调整生命年（QALY）的阈值为50,000欧元，对65岁和70岁的HPV阳性女性进行筛查，对60岁及以上HPV16/18阳性女性直接转诊至阴道镜检查是最优的退出策略（ICER：20,190欧元/质量调整生命年，46,985欧元/质量调整生命年）。与当前策略相比，每100,000名模拟女性中，这一策略可额外预防18例癌症死亡，并减少158例不必要的转诊。对60岁及以上HPV16/18阳性女性直接转诊至阴道镜检查在所有情景下均提高了成本效益。
在荷兰的HPV筛查计划中，为年龄较大的HPV阳性女性增加筛查时机和/或对HPV16/18阳性女性采用直接转诊具有成本效益，并且可以提高筛查的效率和效果。
