论文部分内容阅读
目的:对宫颈刮片结果处于临界或者轻度核异常状态的妇女进行人乳头瘤病毒(HPV)检测以确定是否马上行阴道镜检查。预测该做法对寿命效应、成本及成本效益的影响。设计:模拟研究。研究机构:3个研究中心参与了这项英国国家医疗卫生服务体系(NHS)的引导性研究。人群:25~64岁的宫颈刮片结果处于临界或者轻度核异常状态妇女。干预:采用传统细胞学、液基细胞学以及4种不同年龄截取点和随访次数的策略进行筛查。该策略结合了液基细胞学和HPV检测(辅助的HPV检测)。结果:该模拟研究提示与没有进行HPV检测的传统细胞学方法相比,液基细胞学与HPV检测的联合应用,对于年龄≥35岁宫颈刮片结果处于临界或者轻度核异常状态的妇女,每延长生命年花费为英镑(￡)3735(欧元5528;美元6474),对于年龄处于25~34岁的妇女则延长每生命年需要额外花费￡4233。HPV检测可能减少一生中重复的宫颈刮片检查次数52%~86%,但是会增加阴道镜检查次数64%~138%。结论:对宫颈刮片结果处于临界或者轻度核异常状态的所有妇女均进行HPV检测有可能具有一定的成本效益。然而,预示一生中阴道镜检查的次数增加,需给予慎重考虑。
PURPOSE: To test human papillomavirus (HPV) in women with cervical smear results in critical or mild nuclear abnormalities to determine if colposcopy should be performed immediately. Predict the effect of this approach on life-span, cost and cost-effectiveness. Design: Simulation research. Research Institutions: Three research centers are involved in the pilot study of the British National Health Service System (NHS). Crowds: 25-64-year-old women with cervical smear results at a critical or mild nuclear abnormality. Interventions: Screening was conducted using traditional cytology, liquid-based cytology, and strategies for interception and follow-up at 4 different age groups. The strategy combines liquid-based cytology and HPV testing (assisted by HPV testing). Results: This simulation study suggests that the combination of liquid-based cytology and HPV testing for women with cervical smear results older than 35 years in critical or mild nuclear abnormalities compared with traditional cytology methods without HPV testing, For each additional year of life, £ 3735 (€ 5528; $ 6474) is spent, and for women aged 25-34, an extra £ 4233 per year is required. HPV testing may reduce the number of repeated cervical smear tests 52% ~ 86% of the lifetime, but will increase the number of colposcopy 64% ~ 138%. CONCLUSIONS: HPV testing of all women with cervical smear results in a critical or mildly nuclear anomalous state may be cost-effective. However, predicting an increase in the number of colposcopy in a lifetime requires careful consideration.