HPV基因分型联合p16/ki67双染策略用于宫颈癌筛查成本-效果分析  

Cost-benefit analysis of HPV genotyping combined with p16/ki67 double staining strategy for cervical cancer screening

作　　者：兰丽芳 郑雪群 李娜[2] LAN Lifang;ZHENG Xuequn;LI Na(Department of Gynecology,Liuzhou People's Hospital,Liuzhou,Guangxi 545006,China;Department of Gynecology,First People's Hospital of Chenzhou City,Chenzhou,Hunan 423000,China)

机构地区：[1]柳州市人民医院妇科,广西柳州545006 [2]郴州市第一人民医院妇科,湖南郴州423000

出　　处：《中国优生与遗传杂志》2021年第4期480-483,共4页Chinese Journal of Birth Health & Heredity

摘　　要：目的探讨人乳头瘤病毒(HPV)基因分型联合p16/ki67双染策略用于宫颈癌(CC)筛查的最佳成本效果价值。方法选择2018年1月—2020年4月于柳州市人民医院进行筛查的CC女性患者1037例为研究对象。所有患者均行HPV基因分型、p16/ki67双染及阴道镜活检三种方式,以阴道镜活检为金标准并计算两种筛查方式的灵敏度及特异度相关指标。设计HPV基因分型单独筛查及联合p16/ki67双染的三种不同诊疗方案。根据之前筛查情况计算三种方式对患者普查及疑似病例检查的相关指标,并根据以上指标计算本研究样本CC筛查的总花费及患者平均花费。之后针对三种方式应用于CC筛查的相关指标进行成本-效果分析,评价其合理性。结果HPV基因分型HR-HPV检测及p16/ki67双染检出阳性率显著高于HPV基因分型HPV 16、18检测(P<0.05)。HPV基因分型HR-HPV对疑似病例检测特异度及阳性预测值显著低于HPV基因分型HPV16、18检测及p16/ki67双染(P<0.05)。方案二及方案三对疑似病例检测的特异度、阳性预测及阴性预测值高于方案一(P<0.05)。方案三成本效果比最低,其次为方案一,方案二成本效果比最高。结论HPV基因分型联合p16/ki67双染策略能有效降低CC筛查成本效果比,降低患者筛查成本。Objective To explore the best cost-effective value of human papillomavirus(HPV)genotyping combined with p16/ki67 double staining strategy for cervical cancer(CC)screening.Methods From January 2018 to April 2020,1037 female CC patients were screened in our hospital.All patients underwent HPV genotyping,p16/ki67 double staining and colposcopy biopsy.Taking colposcopy biopsy as the gold standard and calculating the sensitivity and specificity-related indicators of the two screening methods.Three different treatment plans for HPV genotyping alone screening and combined p16/ki67 double staining were designed.According to the previous screening situation,calculate the relevant indicators of patient screening and suspected case examination in three ways,and calculate the total cost of CC screening and the average cost of patients in this study sample based on the above indicators.Then,the cost-benefit analysis is carried out on the relevant indicators of the three methods used in CC screening to evaluate their rationality.Results The positive rate of HPV genotyping HR-HPV detection and p16/ki67 double staining detection was significantly higher than that of HPV genotyping HPV16/18 detection(P<0.05).The detection specificity and positive predictive value of HPV genotyping HR-HPV for suspected cases were significantly lower than those of HPV genotyping HPV16/18 detection and p16/ki67 double staining(P<0.05).The specificity,positive predictive value and negative predictive value of the detection of suspected cases in Scheme 2 and Scheme 3 are significantly higher than those in Scheme 1(P<0.05).Scheme 3 has the lowest cost-effectiveness ratio,followed by Scheme 1,and Scheme 2 has the highest cost-effectiveness ratio.Conclusion HPV genotyping combined with p16/ki67 double staining strategy can effectively reduce the cost-benefit ratio of CC screening and reduce the cost of patient screening.

关 键 词：人乳头瘤病毒基因分型 p16/ki67双染 宫颈癌 成本-效果分析 

分 类 号：R737.33[医药卫生—肿瘤]