宫颈细胞学和HR-HPV检测筛查宫颈病变的成本效果分析  

Cost-effectiveness analysis for cytology and HR-HPV DNA testing in primary cervical screening

作　　者：龙腾飞[1] 彭晓霞[2] 武明辉[3] 张淞文[3] 王建东[1] 张为远[1] 代荫梅[1] 

机构地区：[1]首都医科大学附属北京妇产医院妇科微创中心,北京100026 [2]首都医科大学公共卫生学院,北京100069 [3]北京妇幼保健院群体保健信息管理科,北京100026

出　　处：《中华肿瘤防治杂志》2012年第22期1690-1695,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：北京市科委重大项目(D0906008040491;D09050703570902);北京市教委科技计划面上项目(KM201010025022)

摘　　要：目的:探讨宫颈细胞学和高危型人乳头瘤病毒(HR-HPV)检测筛查宫颈病变的卫生经济学指标,为预防措施的经济效果评价提供依据。方法:对北京地区6 185名已婚妇女采用宫颈液基薄层细胞学(TCT)和TCT联合HR-HPV检测进行宫颈病变流行病学调查,对比分析不同筛查试验的病理学诊断指标,并利用成本-效果分析(CEA)不同筛查方法结局。结果:1)北京地区已婚妇女宫颈细胞学异常的发生率为9.73%,病理结局为宫颈上皮内瘤变(CIN)的构成比为61.79%。其中,宫颈低度病变为79.30%,高度病变为20.16%,镜下早期浸润癌为0.54%。宫颈细胞学异常合并HR-HPV感染阳性人群中病理诊断为CIN的构成比为75.40%。其中,宫颈低度病变为62.57%,高度病变为35.29%,镜下早期浸润癌为2.14%。两种筛查方法病理结局为CIN的构成比比较,诊断宫颈病变差异有统计学意义,P<0.05;诊断宫颈高度病变方面,差异有统计学意义,P<0.05。2)宫颈癌筛查人群以30～44岁年龄阶段为筛查的最佳人群。3)细胞学联合HR-HPV筛查组每筛查出1例组织病理CIN阳性患者平均成本为7 041.47元,而细胞学筛查组为3 131.89元。前者为后者的2.24倍。相同年龄阶段TCT筛查组和TCT+HPV筛查组的成本-效果比较,差异有统计学意义,P<0.01。结论:细胞学检查在筛查宫颈病变方法上具有明显的卫生经济学优势,可以作为宫颈病变的初筛方法。对细胞学检查异常者,HR-HPV检测可以作为诊断CIN的分流措施。这种措施对年龄在30～44岁的人群意义尤为重要。OBJECTIVE： To assess whether the combination of cytology test and high riskhuman papillomavirus （HR-HPV DNA） testing or the sole cytology screening is more effective and cost-effective in prevention of cervical cancer. METHODS： Potential subjects （6 185 women） were screened using two different preventive strategies including sole thin-prep cytology test（TCT） and HR-HPV DNA testing triage for cytology-positive women taken colposcolpy and biopsy as golden standard. A cost-effectiveness analysis （CEA） was adopted to plot the two different strategies and to compare the screening cost and effectiveness. RESULTS： The incidence of cervical lesions was 9.73% in Beijing area. The proportion of the pathology diagnosis of the 602 cytology positive cases as cervical intraepithelial neoplasia （CIN） was 61.79%,of which CIN Ⅰ ,CIN Ⅱ ＆ Ⅲ and cervical carcinoma in situ were 79.30% ,20.16% ,0.54% respectively. And the incidence of CIN of the HR-HPV DNA testing triage cytology positive was 75.40% ,of which CIN Ⅰ ,CIN Ⅱ ＆ Ⅲ and cervical carcinoma in situ were 62.57%, 35.29%, 2.14%, respectively. There were significant difference in detection of CIN and CIN Ⅱ ＆ Ⅲ between the two different strategies（P〈0.05）. The optimal age groups were group 30--44 which could detect more CIN cases. The sole cytology （C/E= ￥7 041.47） was more cost-effective than the HR-HPV DNA testing combined with cytology （C/E= 3/3 131.89）. CONCLUSION： The sole cytology screening strategy was more cost-effec tive. HPV-DNA testing can be as a standard in the triage of high-versus low-risk patients which seems more important in group 30-- 44.

关 键 词：宫颈肿瘤 薄层液基细胞学 高危型人乳头瘤病毒 筛查 成本效果分析 

分 类 号：R737.33[医药卫生—肿瘤]