An evaluation of liquid-based cytology and human papillomavirus testing within the UK cervical cancer screening programme

被引:49
作者
Sherlaw-Johnson, C
Philips, Z
机构
[1] UCL, Dept Math, Clin Operat Res Unit, London WC1E 6BT, England
[2] Univ Nottingham, Sch Econ, Nottingham NG7 2RD, England
关键词
cervical cancer; screening; human papillomavirus; liquid-based cytology; cost-effectiveness;
D O I
10.1038/sj.bjc.6601884
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
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.
引用
收藏
页码:84 / 91
页数:8
相关论文
共 42 条
[1]  
[Anonymous], 2002, EVALUATION HPV LBC C
[2]  
[Anonymous], AHCPR PUBLICATION
[3]  
[Anonymous], 1999, Health Technol Assess
[4]  
BERAL V, 1992, EPIDEMIOLOGY CERVICA, P263
[5]  
*CIPFA, 2002, HLTH SERV DAT 2001
[6]   Cross sectional study of conventional cervical smear, monolayer cytology, and human papillomavirus DNA testing for cervical cancer screening [J].
Coste, J ;
Cochand-Priollet, A ;
de Cremoux, P ;
Le Galès, C ;
Cartier, I ;
Molinié, V ;
Labbé, S ;
Vacher-Lavenu, MC ;
Vielh, P .
BMJ-BRITISH MEDICAL JOURNAL, 2003, 326 (7392) :733-736A
[7]   HUMAN PAPILLOMAVIRUS TESTING BY HYBRID CAPTURE APPEARS TO BE USEFUL IN TRIAGING WOMEN WITH A CYTOLOGIC DIAGNOSIS OF ATYPICAL SQUAMOUS CELLS OF UNDETERMINED SIGNIFICANCE [J].
COX, JT ;
LORINCZ, AT ;
SCHIFFMAN, MH ;
SHERMAN, ME ;
CULLEN, A ;
KURMAN, RJ .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1995, 172 (03) :946-954
[8]   Management of women who test positive for high-risk types of human papillomavirus: the HART study [J].
Cuzick, J ;
Szarewski, A ;
Cubie, H ;
Hulman, G ;
Kitchener, H ;
Luesley, D ;
McGoogan, E ;
Menon, U ;
Terry, G ;
Edwards, R ;
Brooks, C ;
Desai, M ;
Gie, C ;
Ho, L ;
Jacobs, I ;
Pickles, C ;
Sasieni, P .
LANCET, 2003, 362 (9399) :1871-1876
[9]   HPV testing in primary screening of older women [J].
Cuzick, J ;
Beverley, E ;
Ho, L ;
Terry, G ;
Sapper, H ;
Mielzynska, I ;
Lorincz, A ;
Chan, WK ;
Krausz, T ;
Soutter, P .
BRITISH JOURNAL OF CANCER, 1999, 81 (03) :554-558
[10]   HUMAN PAPILLOMAVIRUS TESTING IN PRIMARY CERVICAL SCREENING [J].
CUZICK, J ;
SZAREWSKI, A ;
TERRY, G ;
HO, L ;
HANBY, A ;
MADDOX, P ;
ANDERSON, M ;
KOCJAN, G ;
STEELE, ST ;
GUILLEBAUD, J .
LANCET, 1995, 345 (8964) :1533-1536