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Economic evaluation of HPV DNA test as primary screening method for cervical cancer: A health policy discussion in Greece

机译：HPV DNA试验作为宫颈癌初级筛查方法的经济评价：希腊的健康政策讨论

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BACKGROUND:HPV test appears to be more effective in cervical cancer (CC) screening. However, the decision of its adoption as a primary screening method by substituting the established cytology lies in the evaluation of multiple criteria. Aim of this study is to evaluate the economic and clinical impact of HPV test as primary screening method for CC. METHODS:A decision tree and a Markov model were developed to simulate the screening algorithm and the natural history of CC. Fourteen different screening strategies were evaluated, for women 25-65 years old. Clinical inputs were drawn from the HERMES study and cost inputs from the official price lists. In the absence of CC treatment cost data, the respective Spanish costs were used after being converted to 2017 Greek values. One-way and probabilistic sensitivity analyses were conducted. RESULTS:All screening strategies, that offer as primary screening method triennial HPV genotyping (simultaneous or reflex) alone or as co-testing with cytology appear to be more effective than all other strategies, with regards to both annual CC mortality, due to missed disease (-10.1), and CC incidence(-7.5) versus annual cytology (current practice). Of those, the strategy with HPV test with simultaneous 16/18 genotyping is the strategy that provides savings of 1.050 million euros annually. However, when the above strategy is offered quinquennially despite the fact that outcomes are decreased it remains more effective than current practice (-7.7 deaths and -1.3 incidence) and more savings per death averted (1.323 million) or incidence reduced (7.837 million) are realized. CONCLUSIONS:HPV 16/18 genotyping as a primary screening method for CC appears to be one of the most effective strategies and dominates current practice in respect to both cost and outcomes. Even when compared with all other strategies, the outcomes that it generates justify the cost that it requires, representing a good value for money alternative.
机译：背景：HPV测试似乎是在筛选宫颈癌（CC）更有效。然而，其采用如通过在多个标准评价代既定细胞学在于初级筛选方法的决定。这项研究的目的是评估HPV测试作为CC初筛方法的经济和临床影响。方法：决策树和马尔可夫模型，开发模拟筛选算法和CC的自然史。 14个不同筛查策略进行了评价，对女性25-65岁。临床输入被从官方价目表HERMES的研究和成本投入绘制。在不存在治疗CC成本数据，相应的西班牙语成本被转换成2017希值后使用。进行单向和概率敏感性分析。结果：所有筛查策略，即要约初筛方法三年期HPV基因分型（同时或反射）单独或与细胞学作为共同测试似乎比所有其他战略更加有效，关于这两个年度CC死亡，由于错过了疾病（-10.1），以及CC发病率（-7.5）与年度细胞学检查（目前的做法）。其中，与HPV测试与同时16/18基因分型的策略是每年提供的1.050亿欧元的储蓄策略。然而，当尽管每五年提供的上述策略的结果是降低它仍然比目前的做法更有效避免每死亡（-7.7死亡和发病率-1.3）和更多的储蓄（1323000）或发病率降低（7837000）的实现。结论：HPV基因分型16/18作为CC的初级筛选方法似乎是最有效的策略之一，并在相对于主导目前的做法既成本和结果。即使与其他所有策略相比，结果它产生，它需要，代表货币替代一个很好的价值收不回成本。

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