北京市三阶段新生儿听力筛查成本效果分析

目的 比较新生儿听力筛查两阶段和三阶段的成本效果, 为普遍性筛查提供依据。方法 对2010年10月至2012年12月北京市7家医院出生的正常新生儿进行听力筛查, 分别采用两阶段和三阶段策略及听力诊断性检查, 比较两种筛查的成本/效果比。其中筛查和诊断成本数据源自医院, 采用自行设计问卷对家长调查额外交通费和误工费。根据依从率进行敏感性分析。结果 新生儿初筛62 695人, 未通过5 809人, 阳性率为9.30%;复筛4 933人, 未通过972人, 阳性率为19.70%;复筛未通过并就诊于指定医疗机构者412人。完成诊断性评估360人, 听力异常者217例, 听力异常率为60.28%。完成三阶段筛查共276人, 未通过163人。其中125人完成诊断性检查, 异常112例(中度以上45例), 听力异常率为89.60%。以实际筛查率和诊断率计算成本/效果比, 两阶段(19 985元/例)优于三阶段(37 242元/例), 但随着筛查依从率的提高, 三阶段筛查的成本效果也随之提高。结论 筛查依从率影响三阶段筛查的成本效果, 在筛查依从率较高(>90%)的地区可考虑使用三阶段筛查方法。     

我国结直肠癌筛查卫生经济学证据系统更新：2009－2018

目的 系统更新中国大陆结直肠癌筛查的卫生经济学评价证据。方法 基于2015年发表的系统综述（2004-2014年），扩大检索数据库范围（PubMed、EMbase、The Cochrane Library、Web of Science、中国知网、万方数据知识服务平台、维普中文科技期刊数据库和中国生物医学文献数据库），延展时间至2018年12月，重点呈现近10年证据（2009-2018年）。系统摘录研究基本特征及主要结果。成本数据采用医疗保健类居民消费价格指数均贴现至2017年，计算增量成本效果比（ICER）与对应年份全国人均GDP的比值。结果 最终纳入12篇文献（新增8篇），其中9篇基于人群（均为横断面研究），3篇基于模型。起始年龄多为40岁（7篇），筛查频率多为终生1次（11篇）。筛查技术涉及问卷评估、免疫法粪便隐血试验和结肠镜。经济学评价指标以每检出1例结直肠癌的成本最为常见，中位数（范围，筛查方案数）为52 307元（12 967~3 769 801，n=20）；每检出1例腺瘤的成本为9 220元（1 859~40 535，n=10）。3篇文献报告了与不筛查相比，每挽救1个生命年的成本，其ICER与GDP比值为0.673（-0.013~2.459，n=11），是WHO认为的非常经济有效；不同筛查技术间及不同频率间该比值的范围重叠较大，但起始年龄50岁（0.002，-0.013~0.015，n=3）比40岁（0.781，0.321~2.459，n=8）筛查方案更经济有效。结论 人群研究提示腺瘤检出成本仅为癌症检出成本的1/6，有限的ICER证据提示在我国人群开展结直肠癌筛查经济有效；尽管最优初筛技术无法定论，但初步提示筛查起始年龄50岁优于40岁。未见随机对照试验评价等高级别证据。     

广西壮族自治区专项示范区HIV筛查项目成本效果分析

目的 对2013年广西壮族自治区3个国家科技重大专项示范县开展的HIV筛查项目进行成本效果分析.方法 计算广西HIV筛查项目实施期间执行的经费,统计项目检出的HIV/AIDS和抗病毒治疗数据,建立马尔科夫(Markov)5树模型,评估该项目获得的质量调整生命年(QALY),分析该项目的成本效果.结果 2013年度广西3个示范县区共投入经费1 920.5万元用于HIV筛查项目,检出HIV/AIDS阳性1 218例,3个示范县HIV/AIDS阳性检出的平均成本为1.456万元/例、1.842万元/例和1.404万元/例,通过检出HIV/AIDS获得的QALY平均数分别为12.736、8.523和8.321个,挽回的QALY总数分别为5 973.184个、3 613.752个和2 704.325个;项目整体成本效果为0.156万元/QALY,各示范县分别为0.114万元/QALY、0.216万元/QALY和0.169万元/QALY,A县成本效果指标优于B、C县.结论 广西示范县HIV筛查项目成本效益较好,但HIV/AIDS阳性检出的平均成本较高,加强HIV/AIDS的抗病毒治疗工作有利于提高该项目的成本效益.     

广东省潮州地区农村妇女宫颈癌不同筛查方法的效果评价

目的探讨对广东省潮州地区农村妇女采用高危型人乳头状瘤病毒(HPV)感染、液基细胞学(LBC)和传统巴氏涂片(CPS)筛查法进行宫颈癌筛查的效果,为建立适宜农村地区妇女的宫颈癌筛查策略提供依据。 方法选择2011年3月至6月,采用分阶段整群抽样法在潮州地区5个乡镇招募的3723例35～59岁符合筛查条件的农村常住妇女为研究对象(子宫颈完整存在)。对其同时采用高危型HPV,LBC和CPS筛查法进行宫颈癌筛查,并对其中HPV呈阳性者进行HPV分型。对宫颈细胞学改变为低度鳞状上皮内病变(LSIL)、高度鳞状上皮内病变(HSIL)、HPV呈阳性的未明确诊断意义的不典型鳞状上皮细胞(ASC-US)、非典型鳞状细胞、不能排除高级别鳞状上皮内病变(ASC-H)的受试者,进行阴道镜下宫颈组织活检及随访,评价不同筛查法的筛查效果(本研究遵循的程序符合广东省妇幼保健院人体试验委员会所制定的伦理学标准,得到该委员会批准,并与受试者签署临床研究知情同意书)。 结果3723例接受宫颈癌筛查的受试者中,高危型HPV感染率为8.2%,常见HPV亚型为HPV-52,-16,-58,-33及-68;宫颈上皮内瘤变(CIN)Ⅰ～Ⅲ检出率分别为1.05%(39/3723),0.40%(15/3723)和0.54%(20/3723)。若以宫颈组织病理学活检结果≥CINⅡ为标准,则高危型HPV,LBC和CPS筛查法的灵敏度与特异度分别为94.4%(34/36)与46.6%(27/58),97.2%(35/36)与25.9%(15/58)及52.9%(9/17)与38.0%(19/50)。3种宫颈癌筛查方法的灵敏度与特异度比较,差异均有统计学意义(P<0.05)。LBC与CPS对宫颈癌筛查的阳性预测值(PPV)分别为44.9%(35/78)与22.5%(9/40),且差异具有统计学意义(χ²＝5.7,P＝0.02)。 结论在广东省潮州地区农村妇女中开展宫颈癌筛查发现,高危型HPV检测法相对于LBC,具有更高灵敏度和特异度,在成本许可条件下具有一定推广价值;而LBC相对于CPS,具有更高灵敏度、PPV和更好的制片效果。     

全球肺癌筛查卫生经济学研究的系统评价

目的 了解全球肺癌筛查的卫生经济学评价研究进展,为我国相关研究和筛查工作开展提供参考。方法 系统检索PubMed、EMbase、The Cochrane Library、中国知网及万方数据知识服务平台自建库至2018年6月30日间肺癌筛查卫生经济学研究相关文献,摘录其经济学评价方法及结果等信息,并进行质量评价。成本统一货币单位后计算增量成本效果比（ICER）后计算与当年当地人均GDP比值。结果 共纳入23项研究（1项基于人群随机对照试验,20项完全基于模型评价）,整体质量较好;22项来自发达国家,11项筛查起始年龄为55岁,18项目标人群考虑了吸烟史;评价的筛查技术全部涉及低剂量螺旋CT（LDCT）,筛查频率以每年1次（17项）和终生1次（7项）居多。22项研究可获得与未筛查相比的ICER,其中17项研究报道的ICER低于3倍当年当地人均GDP。各有15项和7项研究可获得每年1次和终生1次的ICER,其中各有12项和7项支持其经济有效,且终生1次略优于每年1次;不同筛查起始年龄和吸烟包年的经济有效性优劣差异不明显。结论 发达国家多开展基于模型LDCT肺癌筛查卫生经济学评价,并结合年龄和吸烟史进行高危人群选择,初步提示该方案经济有效;可为证据有限的欠发达地区提供参考,但实施需结合当地卫生资源现状;预算有限时低频次LDCT筛查更佳,而筛查起始年龄和吸烟史等细节确定需结合人群特征进行精准评价。     

上海市女性乳腺癌不同筛查模式的成本效果分析

目的 对12种由乳腺临床检查（CBE）、乳腺超声检查（US）和乳腺钼靶X线检查（MAM）单独和联合使用组成的乳腺癌筛查模式进行成本效果分析,以期为上海市女性乳腺癌筛查最优方案的制定提供参考和借鉴。方法 利用2008-2012年上海市闵行区同期开展的乳腺癌高危人群筛查项目和乳腺癌有组织筛查项目所获得的信息和成本数据,结合文献相关参数,建立Markov决策树模型。采用队列分析法,以1年为循环周期,共循环40年,模拟10万名45岁女性人群中各种筛查策略下的成本效果。增量成本效果比作为筛选优势策略的指标。通过敏感性分析,评估不同因素对结果的影响大小。结果 在10万名45岁女性中采用不同的筛查策略,进行成本效果分析,结果显示,两年1次CBE结合对阳性者进行US和MAM并联筛查的模式最具成本效果,每挽救1个生命年的成本为182 526元,每增加1个质量调整生命年的成本为144 386元,在可接受的阈值内。敏感性分析结果显示,在最优模式下,上海地区因乳腺癌发病率远超全国平均水平,每增加1个质量调整生命年的成本比全国平均水平低64 836元。结论 上海市女性两年1次CBE结合对阳性者进行US和MAM并联筛查最具成本效果。从社会角度,该筛查模式可以在上海地区推广。     

我国乳腺癌筛查卫生经济学研究的系统评价

目的 了解我国大陆地区乳腺癌筛查的卫生经济学评价进展。方法 系统检索PubMed、中国知网、万方数据知识服务平台和维普网1995年1月至2015年12月收录文献,对纳入研究基本信息、人群项目参与率及检出率、模型研究方法学、经济学评价方法及结果等信息进行摘录和比较,采用卫生经济学评价报告规范（CHEERS）评价报告质量（总分24分）。结果 共检索356篇文献,最终纳入13篇,均发表于近4年（2012-2015年）,其中11篇基于人群、3篇基于模型研究。筛查起始年龄为18～45岁,终止年龄均≥59岁;筛查技术包括临床检查、超声和钼靶单一或联合筛查。有7篇报道了研究角度,其中为政府等服务提供方5篇,社会角度2篇;仅有5篇研究进行了成本和（或）效果贴现。11篇成本-效果分析中,有9篇提供了评价指标检出1例乳腺癌的成本,为5.0～229.3（M=14.5）万元。以质量调整生命年（QALY）或伤残调整生命年（DALY）为指标的成本-效用分析仅4篇,相应增量成本效果比（ICER）为0.3万元～27.1万元（2015年我国人均GDP为4.9万元）。13篇文献平均得分14.5（9.5～21.0）分,总分24分,其中研究角度、贴现率、ICER及不确定性等维度得分较低。结论 我国大陆地区乳腺癌筛查的经济学研究尚处于起步阶段,尤其是模型研究;各研究间方法及结果可比性一般,报告质量有待加强。应从社会角度全面核算成本后对筛查项目开展以QALY或DALY为指标的成本-效用分析。     

浙江省成年居民高血压前期患病率及其危险因素的研究

目的 <\b>探讨浙江省成年居民高血压前期患病率及其危险因素.方法 <\b>采用多阶段分层整群随机抽样方法,于2010年7-11月在浙江省15个县区选择年龄≥18周岁常住人口作为研究对象,进行问卷调查和体检并采集空腹静脉血标本.数据分析采用x2检验、t检验和logistic回归模型.结果 <\b>共调查成年居民17 437(男性8169、女性9268)人.高血压前期患病率为34.39％,其中男性患病率(38.57％)高于女性(30.70％)(x2=119.36,P＜0.0001).≥25岁男性高血压前期患病率随年龄增加逐渐下降(x2=76.94,P＜0.0001),≥45岁女性高血压前期患病率随年龄增加呈下降趋势(x2=114.66,P＜0.0001).城市居民高血压前期患病率为32.39％,农村为35.60％,农村高于城市(x2=18.69,P＜0.0001).多因素非条件logistic回归分析提示,男性、年龄(≥35岁)、腰围(男≥85 cm、女≥80 cm)、BMI(≥25.0 kg/m2)、TG≥1.7 mmol/L为高血压前期的危险因素,文化程度高是高血压前期的保护因素.结论 <\b>浙江省成年居民高血压前期患病率较高,主要影响因素有超重、肥胖、血脂异常等.     

宫颈癌筛查方案的成本效果评价：基于江浙沪地区

目的结合指南推荐和我国目前宫颈癌筛查的实践工作,从社会角度对6种宫颈癌筛查方案的成本效果进行评估。方法运用TreeAge Pro 2018软件构建Markov队列模型,模拟10万名初始年龄为15岁的健康妇女人群50年内的人乳头瘤病毒(human papillomavirus,HPV)感染、癌前病变到宫颈癌的病程,并对模拟的各筛查方案进行成本效果评价。结果 6种筛查方案每2年、3年和5年1次的成本效果排序(从好到差)均依次为:HPV高危分型筛查、液基细胞学检测(thinprep cytologic test,TCT)联合HPV高危分型、HPV高危亚型筛查、巴氏细胞学检测(Pap cytologic test,PAP)联合HPV高危分型筛查、TCT、PAP。HPV高危分型每5年1次筛查成本效果最优。以江浙沪地区2018年人均国内生产总值(11.7万元)作参考,TCT联合HPV高危分型筛查每5年1次筛查相较于最优成本效果方案的增量成本效果比最小且可以被接受。结论从社会角度考虑,可优先考虑选择HPV高危分型每5年1次筛查。建议在经济条件允许的情况下,可以选择TCT联合HPV高危分型筛查每5年1次筛查。     

细胞学检测为非典型鳞状细胞且人乳头瘤病毒阴性妇女的宫颈癌患病风险评估

目的 评估宫颈癌筛查中非典型鳞状细胞(ASC-US)但人乳头瘤病毒(HPV)阴性的妇女罹患中度及以上宫颈上皮内瘤样病变(CIN2+)的风险。方法 汇总1999-2008年在我国开展的17项以人群为基础的宫颈癌筛查横断面研究,共30371名17~59岁妇女参加筛查,所有妇女均进行了液基细胞学检查(LBC)、HPV检测(hybrid capture 2, HC2)和醋酸染色肉眼观察法(VIA),任一结果阳性者转诊阴道镜。最终28810名具有完整细胞学、HPV、病理检测结果的妇女纳入分析,分别以细胞学正常且HPV阴性组(LBC-/HPV-)、细胞学正常组(LBC-)为参照,评估细胞学为ASC-US且HPV阴性组(ASC-US/HPV-)的CIN2+患病风险。结果 LBC-/HPV-、LBC-和ASC-US/HPV-组分别有22003、24139和1834名妇女,CIN2+的患病率分别为0.05%、0.36%和0.16%。分别以LBC-/HPV-组、LBC-组为参照,ASC-US/HPV-组罹患CIN2+的风险分别为3.00(95%CI:0.85~10.65)和0.46(95%CI:0.15~1.45),其校正OR值分别为4.00(95%CI:1.08~14.87)、0.47(95%CI:0.15~1.49)。结论 ASC-US/HPV-妇女CIN2+的患病风险介于LBC-和LBC-/HPV-妇女之间。依据"同等风险、同等管理"的原则,可采用对LBC-者的3年筛查间隔,而对于卫生资源相对匮乏地区可采用对LBC-/HPV-者的5年筛查间隔。     

高危型人乳头瘤病毒核酸检测试剂盒-Care HPV用于宫颈癌及癌前病变筛查的临床价值

目的 评价care HPV用于宫颈癌及癌前病变筛查的临床价值。方法 收集2010年至2012年南京鼓楼医院妇科就诊的年龄在30~59岁之间的妇女宫颈样本,行care HPV、第二代杂交捕获技术（HC2）、HPV聚合酶链反应（HPV-PCR）及宫颈液基细胞学（TCT）检查,TCT≥ASC-US者行阴道镜宫颈活检及必要时宫颈管诊刮,以组织病理学为金标准。病理诊断≥CIN2者为高危病变组,炎症/CCIN 1为良性病变组。结果 共收集404例有效样本。高危组42例、良性组50例,正常组312例。care HPV和HC2检测结果 的一致性为Kappa=0.833（P〈0.0001）,一致率93.81%;care HPV和HPV-PCR检测结果 的一致性为Kappa=0.707（P〈0.0001）,一致率88.12%;care HPV检出≥CIN 2的灵敏度为85.71%,特异度为83.15%。结论 care HPV与HC2、HPV-PCR试剂具有高度一致性。care HPV在检出HPV感染上具有很好的灵敏度和特异性,检测耗时短,有望成为医疗资源相对贫乏地区子宫颈癌及癌前病变筛查的主要方法 。     

Cost-effectiveness of primarily human papillomavirus-based cervical cancer screening in settings with currently established Pap screening: a systematic review commissioned by the German Federal Ministry of Health

OBJECTIVES: The aim of this study was to summarize the current evidence for the cost-effectiveness of primarily human papillomavirus (HPV) -based cervical cancer screening in settings with already established Papanicolaou test (Pap) programs. Emphasis was placed on the German situation with annual Pap screening. METHODS: Medical, economic, and health technology assessment (HTA) databases were systematically searched for cost-effectiveness studies comparing HPV to Pap screening. Study data were extracted, standardized, and summarized in cost-effectiveness plots contrasting HPV strategies to Pap screening with 1-, 2-, 3-, and 5-years interval. For each Pap setting, the likelihood of cost-effective HPV screening was assessed depending on willingness-to-pay. RESULTS: We reviewed twelve decision-analytic cost-effectiveness models. Study results showed wide variation due to methodical heterogeneity. Data synthesis revealed that the cost-effectiveness of HPV screening depends on the interval of the established Pap screening strategy. In comparison with Pap screening every 2 years, only 25 percent of the HPV-based screening strategies were cost-effective. However, in comparison with Pap screening every 1, 3, or 5 years, 83 percent, 55 percent, and 92 percent of HPV screening strategies were cost-effective, respectively. Results for settings with annual Pap screening are based on models assuming 100 percent screening coverage. CONCLUSIONS: The introduction of HPV-based screening programs is cost-effective if the screening interval of the established Pap program exceeds 2 years. In settings with biennial Pap screening, introduction of HPV-based screening is unlikely to be cost-effective. Results also suggest cost-effectiveness of HPV-based screening in settings with annual Pap screening; however, this finding should be confirmed under realistic screening adherence assumptions.     

Effect of number of human papillomavirus vaccine doses on guideline adherent cervical cytology screening among 19–26 year old females

PurposeLittle is known about how the number of HPV vaccine doses affect adherence to screening guidelines. This study compared adherence to cervical cancer screening by the number of HPV vaccine doses received by young women and assessed whether the specialty of vaccinating providers affected behavior.MethodsThis retrospective cohort study using administrative insurance claims records included 24,964 19–26 year old women who received at least 1 injection of the HPV vaccine between January 2006 and November 2009. Vaccinated young women continuously enrolled in a nationally-representative private insurance plan for 6 months prior to and 37 months after HPV vaccine administration were included. Logistic regression was used to compare the odds of Papanicolaou (Pap) testing 3 years after vaccine initiation by number of vaccine doses and provider type.ResultsIn this sample, 79.3% had a Pap test 3 years following vaccine initiation. Receiving 1 (aOR: 0.60, 95% CI 0.55–0.65) or 2 (aOR: 0.80, 95% CI 0.74–0.87) doses was associated with decreased odds of Pap testing compared to 3 doses. Many young women in our sample (16.5%) were diagnosed with cervical dysplasia prior to HPV vaccination. Patients vaccinated by non-obstetrician/gynecologists were less likely to get a Pap test following vaccination.ConclusionsWomen who received 1 or 2 doses of the HPV vaccine were less likely than those who received 3 doses to be screened for cervical cancer 3 years following vaccine initiation. Pediatricians and primary care physicians should convey the importance of initiating and continuing screening to HPV vaccinated patients.     

新疆维吾尔自治区哈萨克族女性HPV感染型别分布及危险因素分析

目的 评价新疆维吾尔自治区哈萨克族女性高危型HPV（HR-HPV）感染率及型别分布,评估子宫颈病变分布及其与HPV感染的相关性,并对HPV感染的危险因素进行初步分析。方法 2018年6月在新疆维吾尔自治区托里县开展以人群为基础的子宫颈癌筛查研究,共招募2 000名25~64岁哈萨克族女性。每位女性采集3份子宫颈脱落细胞标本,分别行careHPV（不分型）、PCR HPV、p16^INK4a及薄层液基细胞学检测,并对任一检测结果阳性者转诊阴道镜,阴道镜检查结果异常者在病变处取活检。病理结果作为最终诊断的金标准。结果 HPV总的感染率为14.55%,其中HR-HPV感染率为12.90%,且在50~54岁年龄组最高;常见的5种HR-HPV基因型别为HPV16（2.80%）、HPV51（2.35%）、HPV52（1.70%）、HPV56（1.50%）和HPV39型（1.20%）;HPV以单一感染者居多（71.48%）;50~54岁年龄组多重感染率最高,多重感染者中以双重感染为主（69.88%）,且HPV42和HPV56是最常见的合并感染型别;子宫颈上皮内瘤样病变1级中HPV16（31.82%）、HPV51（27.27%）和HPV18（13.64%）型感染率较高;子宫颈上皮内瘤样病变2级中HPV16型（57.14%）感染率较高;子宫颈上皮内瘤样病变3级及以上中HPV16（55.56%）和HPV18（33.33%）型感染率较高;多因素logistic回归结果显示,文化程度高、绝经及梅毒感染会增加HPV感染的可能性。结论 哈萨克族女性HR-HPV以HPV16、51、52型别较为常见;HR-HPV感染与文化程度、绝经状况及梅毒感染有关,需针对高危因素制定相应措施,重视性病患者和>50岁女性的筛查工作,进行有效干预。     

某市妇女子宫颈癌筛查及HPV疫苗认知调查

目的了解山西省某市城乡居民在子宫颈癌筛查以及接受人乳头瘤病毒(HPV)疫苗接种的情况。方法采用整群抽样调查方法,对某市城区和农村≥25岁女性进行子宫颈癌筛查并对HPV疫苗接受情况进行调查。结果共调查2 269名女性,其中城市居民341人,农村居民1 928人;有43.4%的城区和76.5%的农村女性知晓子宫颈癌,72.4%的城区和78.9%的农村女性了解子宫颈癌筛查的目的 ,23.8%的城市和6.1%的农村女性知晓HPV的传播途径,78.3%的城区和92.2%的农村女性愿意支付部分筛查产生的费用,且愿意支付的费用在每人100元以内;而对预防子宫颈癌的HPV疫苗,仅有50.7%城区和34.6%农村女性愿意接种,不愿意接种的主要原因是价格因素。结论降低子宫颈癌筛查和接种HPV疫苗的费用,或及早实现HPV疫苗生产的国产化以降低价格,加大人群子宫颈癌防治的宣传教育,对子宫颈癌的防治有重要意义。     

Prevalence of genital HPV infection in urban and rural women in the Eastern Brazilian Amazon

This study investigated the prevalence and risk factors for genital infection with HPV in women from rural and urban areas in two different regions of the Eastern Brazilian Amazon. A cross-sectional survey was performed in Pap screening programs, with a total sample of 444 women (233 urban and 211 rural). Uterine cervical swabs were collected for the detection of HPV DNA with the established PCR assay using MY09-MY11. All volunteers answered an epidemiological questionnaire. Bivariate and multivariate logistic regression analyses were performed to identify risk factors associated with HPV infection. Overall prevalence of HPV infection was 14.6% (15% in urban women and 14.2% in rural). The only factor associated with HPV was marital status in the 13-25-year-old rural population, with higher HPV prevalence among single and divorced women and widows. The findings indicate the need for risk factor control strategies targeted specifically to women in rural and urban areas.     

Sexual Orientation Differences in Cervical Cancer Prevention among a Cohort of U.S. Women

BackgroundAlthough much has been published in recent years on differences in Papanicolaou (Pap) tests across sexual orientation, other aspects of cervical cancer prevention remain underexplored, such as human papillomavirus (HPV) vaccination, HPV co-tests, or abnormal Pap tests.MethodsData came from participants (aged 24–54 years) enrolled in an ongoing, longitudinal, U.S.-based cohort study, the Nurses’ Health Study 3 (N = 12,175). Analyses were restricted to participants who met the current guidelines for care (e.g., ≥21 years of age for Pap tests).ResultsMostly heterosexual women were more likely to initiate HPV vaccination than completely heterosexual women with no same-sex partners. All other comparisons across sexual orientation for HPV vaccination initiation and completion and the age of initiation were not statistically significant. Compared with completely heterosexual women with no same-sex partners, mostly heterosexual and lesbian women had lower odds of having a Pap test within the past 2 years. Completely heterosexual women with same-sex partners, mostly heterosexual women, and bisexual women had their first Pap test at an earlier age, had higher odds of having an HPV co-test, and had higher odds of having a positive HPV or abnormal Pap test compared with completely heterosexual women with no same-sex partners. In contrast, lesbian women had lower odds of having positive HPV or abnormal Pap results (odds ratio, 0.65; 95% confidence interval, 0.49–0.86) than completely heterosexual women with no same-sex partners.ConclusionsThere are significant differences across sexual orientation groups in cervical cancer prevention for Pap test timing and positive HPV and abnormal Pap tests, but few differences in HPV vaccination initiation, completion, and age at initiation. Interventions should focus on increasing routine Pap testing among mostly heterosexual and lesbian women.     

Disparities in Receipt of Breast and Cervical Cancer Screening for Rural Women Age 18 to 64 with Disabilities

BackgroundPrevious research has found breast and cervical cancer screening disparities between women with and without disabilities, and between women living in rural versus urban areas. Living in a rural area may add to the barriers women with disabilities experience when attempting to obtain screening for breast and cervical cancer. The purpose of this study was to examine the combination of disability status and rurality in association with receipt of breast and cervical cancer screening among women age 18 to 64 in the United States.MethodsWe conducted cross-sectional analyses of data from the Medical Expenditure Panel Survey, using pooled annual data files from 2002 through 2008. We compared recent receipt of breast and cervical cancer screening among four groups: 1) urban women without disabilities, 2) urban women with disabilities, 3) rural women without disabilities, and 4) rural women with disabilities.FindingsOverall, women with disabilities were less likely to be up to date with mammograms and Pap tests compared with women with no disabilities. Similarly, women in rural areas were less likely to have received breast or cervical cancer screening within recommended timeframes. Women who both had a disability and lived in a rural area were the least likely to be current with screening.ConclusionsOur findings suggest that living in rural regions compounds disparities in receipt of cancer screening among women with disabilities. Increased attention is needed to improve receipt of cancer screening among rural women with disabilities.     

HPV检测技术初筛巴氏涂片分流应用于农村女性宫颈癌筛查效果

目的 分析人乳头瘤病毒（human papillomavirus,HPV）检测技术初筛巴氏涂片分流应用于农村女性宫颈癌筛查中的效果。方法 2015年对35~64岁农村女性使用HPV检测进行宫颈癌初筛,阳性者采用巴氏涂片法分流,巴氏涂片结果为不明确意义的非典型鳞状细胞（atypical squamous cells of undetermined signification,ASC-US）及以上病变的女性转用阴道镜检查。所有阴道镜下检查异常或不满意处均取活检或宫颈管搔刮术（endocervical canal curettage,ECC）,病理结果为中度子宫颈上皮内瘤变（cervical intraepithelial neoplasia grade 2,CIN2）及以上者转诊进行手术治疗。结果 HPV初筛、巴氏涂片分流策略HPV筛查阳性率为10.65%。CIN2及以上者共150人,全部进行阴道镜检查,实际阴道镜转诊率为3.55%,阴道镜顺应性为100%。经病理诊断,本次筛查分别发现轻度子宫颈上皮内瘤变（cervical intraepithelial neoplasia grade 1,CIN1）、CIN2及以上、重度子宫颈上皮内瘤变（cervical intraepithelial neoplasia grade 3,CIN3）及以上分别为16例（0.38%）、29例（0.69%）、15例（0.36%）,未发现宫颈癌病例。结论 HPV初筛、巴氏涂片分流策略能够降低阴道镜转诊率,宫颈疾病检出率较高,可以在有条件的农村地区使用。但宫颈癌前病变及宫颈癌的检出率较HPV初筛不分流低,需要进一步加强对基层细胞学医生技术水平的规范化培训。     

Cost-Effectiveness of 21 Alternative Cervical Cancer Screening Strategies

ObjectivesThe aim of this study is to assess the cost-effectiveness of 21 alternative cervical cancer screening (CCS) strategies.MethodsA cohort simulation model was developed to determine from a health systems perspective the cost-effectiveness of the 21 alternative CCS strategies that incorporated combinations of Papanicolaou's smear test (PAP), liquid-based cytology (LBC) or human papillomavirus deoxyribonucleic acid (HPV-DNA) testing. The model was calibrated to categorize total costs into four budgetary authorities: testing, physician, inpatient, and outpatient services. Within each category, alternative screening strategies were contrasted in terms of their cost impacts and the percent change calculated within each category. Epidemiologic data and costs were derived from administrative health databases. Estimates of test characteristics and quality-adjusted life years (QALYs) were derived from available literature.ResultsThree-year screening with PAP and HPV-DNA triage testing for women older than 30 years of age (3-year PAP + HPV + PAP-age) is less costly and more effective saving $16,078 per additional QALY gained. Although there was an associated net cost decrease of 4.2% driven by a reduction in testing and physician costs of 22.1% and 18.6%, respectively, there is a cost increase of 0.8% and 27.7% in inpatient and outpatient services, respectively.ConclusionThere is economic evidence to support adopting 3-year PAP + HPV + PAP-age. Budgetary resources can potentially be shifted from testing and physician services to fund the additional resource requirements for inpatient and outpatient services.