文章：

分子检测作为宫颈癌筛查分流策略：基于顶空分析的经济学评估

Molecular Testing as Triage in Cervical Cancer Screening: Economic Evaluation Using Headroom Analysis

原文发布日期：11 February 2025

DOI: 10.3390/cancers17040612

类型: Article

开放获取: 是

英文摘要：

Background:Molecular triage testing for high-risk human papillomavirus (hrHPV)-based cervical cancer screening can be used in self-sampling, potentially reducing unnecessary colposcopies and increasing attendance. However, its commercial value remains underexplored. This study used headroom analysis to estimate the maximum reimbursable price (MRP) at which molecular testing would be cost-effective for the triage of hrHPV-positive women, compared with cytology.Methods:A validated microsimulation Markov model for the Dutch cervical cancer screening program evaluated three triage scenarios: (1) cytology (base scenario), (2) molecular testing in self-samples only (scenario I), and (3) molecular testing on self- and GP-collected samples (scenario II). Test sensitivity and specificity ranged from 65% to 95%, with a threshold of EUR 20,000 per life-year gained.Results: In scenario I, MRPs ranged from EUR 244 (85% sensitivity, 75% specificity) to EUR 435 (95% sensitivity, 95% specificity). In scenario II, molecular testing was cost-effective across all parameters, with MRPs from EUR 162 (65% sensitivity, 65% specificity) to EUR 624 (95% sensitivity, 95% specificity). Increasing the sensitivity did not significantly affect life-years gained (due to the low mortality of cervical cancer in the Netherlands), but increased specificity did reduce the number of unnecessary colposcopies.Conclusions: Enhancing the specificity of molecular triage testing will improve its commercial value by reducing colposcopy referrals without affecting the number of life-years gained.

摘要翻译： 

背景：基于高危型人乳头瘤病毒（hrHPV）的宫颈癌筛查中，分子分流检测可用于自采样，可能减少不必要的阴道镜检查并提高参与率。然而，其商业价值尚未得到充分探索。本研究采用顶空分析法，评估与细胞学检查相比，对hrHPV阳性女性进行分子分流检测具有成本效益时的最高可报销价格（MRP）。 方法：采用经过验证的荷兰宫颈癌筛查项目微观模拟马尔可夫模型，评估三种分流方案：（1）细胞学检查（基础方案），（2）仅对自采样样本进行分子检测（方案I），以及（3）对自采样和全科医生采集样本均进行分子检测（方案II）。检测的敏感性和特异性设定在65%至95%之间，成本效益阈值设定为每获得一个生命年20,000欧元。 结果：在方案I中，MRP范围从244欧元（敏感性85%，特异性75%）到435欧元（敏感性95%，特异性95%）。在方案II中，分子检测在所有参数下均具有成本效益，MRP范围从162欧元（敏感性65%，特异性65%）到624欧元（敏感性95%，特异性95%）。提高敏感性对获得的生命年数量影响不大（由于荷兰宫颈癌死亡率较低），但提高特异性确实减少了不必要的阴道镜检查数量。 结论：提高分子分流检测的特异性，可在不影响获得生命年数量的情况下减少阴道镜转诊，从而提升其商业价值。

原文链接：

Molecular Testing as Triage in Cervical Cancer Screening: Economic Evaluation Using Headroom Analysis