Present evidence on the value of HPV testing for cervical cancer screening: a model-based exploration of the (cost-)effectiveness.
Present evidence on the value of HPV testing for cervical cancer screening: a model-based exploration of the (cost-)effectiveness.
复制标题
目前有关 HPV 检测对于宫颈癌筛查价值的证据：基于模型的（成本）效益探索。
作者：
M. Ballegooijen;ME van Marle;PG Warmerdam;C. Meijer;Jmm Walboomers;J. Habbema
人乳头瘤病毒（HPV）是宫颈癌的主要危险因素。高风险比率在HPV流行率的横断面数据中发现。提出的问题是，目前的证据是否足以对HPV筛查提出坚定的建议。通过将HPV感染作为宫颈上皮内瘤变（CIN）的可能前兆，扩展了经验证的宫颈癌筛查模型。构建了两种截然不同的模型定量，以便两者与观察到的HPV风险比相容。一个模型假设在进展为CIN之前HPV感染的持续时间要长得多，并且HPV检测的敏感性高于另一个模型。在模型的一个版本中，计算出的HPV筛查的死亡率降低更高，（成本）效益比巴氏涂片筛查好得多。在另一个版本中，结果相反，尽管HPV +细胞学联合检测的成本效益接近巴氏涂片筛查。虽然小型随访研究和设计强度有限的研究表明，HPV检测可以很好地改善宫颈癌筛查，但只有关于HPV感染与肿瘤发生之间关系的大型纵向筛查研究才能给出结果，从而能够对HPV筛查的（成本）有效性做出明确的结论。前瞻性研究应针对30-60岁的妇女。
Human papillomavirus (HPV) is the main risk factor for invasive cervical cancer. High risk ratios are found in cross-sectional data on HPV prevalence. The question raised is whether this present evidence is sufficient for making firm recommendations on HPV screening. A validated cervical cancer screening model was extended by adding HPV infection as a possible precursor of cervical intraepithelial neoplasia (CIN). Two widely different model quantifications were constructed so that both were compatible with the observed HPV risk ratios. One model assumed a much longer duration of HPV infection before progressing to CIN and a higher sensitivity of the HPV test than the other. In one version of the model, the calculated mortality reduction from HPV screening was higher and the (cost-)effectiveness was much better than for Pap smear screening. In the other version, outcomes were the opposite, although the cost-effectiveness of the combined HPV + cytology test was close to that of Pap smear screening. Although small follow-up studies and studies with limited strength of design suggest that HPV testing may well improve cervical cancer screening, only large longitudinal screening studies on the association between HPV infection and the development of neoplasias can give outcomes that would enable a firm conclusion to be made on the (cost-)effectiveness of HPV screening. Prospective studies should address women aged 30-60 years.
影响因子：
10.3
作者：
HO, GYF;BURK, RD;ROMNEY, S
通讯作者：
ROMNEY, S