Cost-effective management of women with minor cervical lesions: Revisiting the application of HPV DNA testing.
Cost-effective management of women with minor cervical lesions: Revisiting the application of HPV DNA testing.
复制标题
对患有轻微宫颈病变的女性进行具有成本效益的管理：重新审视 HPV DNA 检测的应用。
DOI：
10.1016/j.ygyno.2016.08.231
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发表时间：
2016
影响因子：
4.7
通讯作者：
Kim,JaneJ
中科院分区：
文献类型：
--
作者：
Pedersen,Kine;Burger,EmilyA;Sy,Stephen;Kristiansen,IvarS;Kim,JaneJ
背景 对患有轻微宫颈病变的女性的管理指南缺乏共识，加上人乳头瘤病毒 (HPV) 基因分型等新型筛查方法，有必要重新审视预防政策。我们评估了替代分诊策略的成本效益和资源权衡，为挪威的宫颈癌预防提供信息。方法我们使用决策分析模型来比较与对患有轻微宫颈病变的女性进行分类的十种新候选方法相关的终生健康和经济后果。候选策略各有不同：1) 分类检测：HPV 检测与细胞学相结合、单独 HPV 检测（带或不带 HPV-16 和 18 基因分型）以及立即阴道镜检查，以及 2) 索引和分类检测之间的时间长度（即 6、12 或 18 个月）。模型结果包括质量调整生命年（QALY）、终生社会成本和资源使用（例如阴道镜转诊）。结果 与候选策略相比，当前的挪威指南效率较低且成本较高。鉴于挪威普遍提及的支付意愿门槛为每获得 QALY 100,000 美元，首选策略包括 HPV 基因分型，如果 HPV-16 或 18 呈阳性，则立即转诊阴道镜检查；如果是非 HPV-16 或 18 阳性，则在 12 个月时重复进行 HPV 检测（每获得 QALY 78,010 美元）。候选策略之间的健康益处差异很小，而资源利用差异很大。更有效的策略需要与当前水平相比适度增加阴道镜检查转诊次数（例如，首选策略增加 9%）。结论 HPV 检测的新应用可以改善对患有轻微宫颈病变的女性的管理，但同时也会增加后续程序。
Background Lack of consensus in management guidelines for women with minor cervical lesions, coupled with novel screening approaches, such as human papillomavirus (HPV) genotyping, necessitate revisiting prevention policies. We evaluated the cost-effectiveness and resource trade-offs of alternative triage strategies to inform cervical cancer prevention in Norway. Methods We used a decision-analytic model to compare the lifetime health and economic consequences associated with ten novel candidate approaches to triage women with minor cervical lesions. Candidate strategies varied by: 1) the triage test (s): HPV testing in combination with cytology, HPV testing alone with or without genotyping for HPV-16 and-18, and immediate colposcopy, and 2) the length of time between index and triage testing (ie, 6, 12 or 18 months). Model outcomes included quality-adjusted life-years (QALYs), lifetime societal costs, and resource use (eg, colposcopy referrals). Results The current Norwegian guidelines were less effective and more costly than candidate strategies. Given a commonly-cited willingness-to-pay threshold in Norway of $100,000 per QALY gained, the preferred strategy involved HPV genotyping with immediate colposcopy referral for HPV-16 or-18 positive and repeat HPV testing at 12 months for non-HPV-16 or-18 positive ($78,010 per QALY gained). Differences in health benefits among candidate strategies were small, while resource use varied substantially. More effective strategies required a moderate increase in colposcopy referrals (eg, a 9% increase for the preferred strategy) compared with current levels. Conclusion New applications of HPV testing may improve management of women with minor cervical lesions, yet are accompanied by a trade-off of increased follow-up procedures.