Background

The guidelines for managing abnormal cervical cancer screening tests changed from a results-based approach in 2012 to a risk-based approach in 2019.

Objective

We estimated the cost-effectiveness of the 2019 management guidelines and the changes in resource utilization moving from 2012 to 2019 guidelines.

Study Design

We utilized a previously published model of cervical cancer natural history and screening to estimate and compare the lifetime costs and the number of screens, colposcopies, precancer treatments, cancer cases, and cancer deaths associated with the 2012 vs 2019 management guidelines. We assessed these guidelines under the scenarios of observed screening practice and perfect screening adherence to 3-year cytology starting at age 21, with a switch to either 3-year or 5-year cytology plus human papillomavirus cotesting at age 30. In addition, we estimated the lifetime costs and life years to determine the cost-effectiveness of shifting to the 2019 management guidelines.

Results

Under the assumptions of both observed screening practice and perfect screening adherence with a strategy of 3-year cytology at ages 21 to 29 and switching to 3-year cotesting at age 30, the management of the screening tests according to the 2019 guidelines was less costly and more effective than the 2012 guidelines. For 3-year cytology screening at ages 21 to 29 and switching to 5-year cotesting at age 30, the 2019 guidelines were more cost-effective at a willingness-to-pay threshold of $100,000 per life year gained. Across all scenarios, the 2019 management guidelines were associated with fewer colposcopies and cancer deaths.

Conclusion

Our model-based analysis suggests that the 2019 guidelines are more effective overall and also more cost-effective than the 2012 guidelines, supporting the principle of “equal management of equal risks.”

中文翻译：

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2019年美国阴道镜和宫颈病理学会基于风险的管理共识指南对异常宫颈癌筛查测试和癌症前兆进行管理的成本效益分析

背景

管理异常宫颈癌筛查测试的指南从 2012 年的基于结果的方法变为 2019 年的基于风险的方法。

客观的

我们估计了 2019 年管理指南的成本效益以及从 2012 年到 2019 年指南的资源利用变化。

学习规划

我们利用先前发表的宫颈癌自然史和筛查模型来估计和比较与 2012 年与 2019 年管理指南相关的终生成本和筛查次数、阴道镜检查、癌前治疗、癌症病例和癌症死亡人数。我们在观察到的筛查实践和从 21 岁开始完全遵循 3 年细胞学检查的情况下评估了这些指南，并在 30 岁时转换为 3 年或 5 年细胞学检查加人乳头瘤病毒联合检测。此外，我们估计了生命周期成本和生命年数，以确定转向 2019 年管理指南的成本效益。

结果

在观察到的筛查实践和完美的筛查依从性的假设下，在 21 至 29 岁时采用 3 年细胞学检查策略并在 30 岁时转换为 3 年联合检测，根据 2019 年指南管理筛查检测的成本较低并且比 2012 年的指南更有效。对于 21 至 29 岁的 3 年细胞学筛查并在 30 岁时转为 5 年联合检测，2019 年指南更具成本效益，每增加一个生命年的支付意愿阈值为 100,000 美元。在所有情况下，2019 年管理指南与更少的阴道镜检查和癌症死亡有关。

结论

我们基于模型的分析表明，2019 年指南总体上更有效，也比 2012 年指南更具成本效益，支持“同等风险同等管理”的原则。