An evaluation of liquid-based cytology and human papillomavirus testing within the UK cervical cancer screening programme
An evaluation of liquid-based cytology and human papillomavirus testing within the UK cervical cancer screening programme
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DOI：
10.1038/sj.bjc.6601884
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发表时间：
2004-07-05
影响因子：
8.8
通讯作者：
Philips, Z
中科院分区：
文献类型：
--
作者：
Sherlaw-Johnson, C;Philips, Z
本研究的目的是评估将液基细胞学 (LBC) 和人乳头瘤病毒 (HPV) 检测引入英国宫颈癌筛查计划的不同选择。其中包括将 HPV 检测作为轻度和边缘涂片异常的分类或作为初级筛查测试的选项。结果包括对资源使用、总成本、使用寿命和成本效益的预测影响。已经进行了广泛的敏感性分析，以探讨与疾病自然史相关的不确定性的重要性以及筛查的影响。在基线假设下，引入 LBC 的不同选择的成本效益似乎是有利的，并且在其对细胞学诊断有效性影响的一系列假设下，这些结果是一致的。然而，如果我们假设 LBC 的边际成本高于传统方法，则预计在不使用 LBC 的情况下，初级涂片检测选项将更具成本效益。 LBC 初级涂片和 HPV 检测相结合（间隔 5 年）在成本和有效性方面与其他 3 年一次的初级涂片检测或单独初级 HPV 检测的选择相似。然而，初级 HPV 检测和组合选择都会导致女性一生中不适当阴道镜检查的风险大大增加。
The aim of this study is to evaluate different options for introducing liquid-based cytology (LBC) and human papillomavirus (HPV) testing into the UK cervical cancer screening programme. These include options that incorporate HPV testing either as a triage for mild and borderline smear abnormalities or as a primary screening test. Outcomes include the predicted impact on resource use, total cost, life years and cost-effectiveness. Extensive sensitivity analysis has been carried out to explore the importance of the uncertainty associated with disease natural history and the impact of screening. Under baseline assumptions, the cost-effectiveness of different options for introducing LBC appears favourable, and these results are consistent under a range of assumptions for its impact on the diagnostic effectiveness of cytology. However, if we assume a higher marginal cost of LBC in comparison to conventional methods, primary smear testing options are predicted to be more cost-effective without LBC. Combined LBC primary smear and HPV testing with a 5-year interval is similar in both cost and effectiveness to the other 3-yearly options of primary smear testing or primary HPV testing alone. However, both primary HPV testing and combined options would give rise to a far greater risk of inappropriate colposcopy throughout a woman's lifetime.