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Is the HPV-test more cost-effective than cytology in cervical cancer screening? An economic analysis from a middle-income country
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  • Diama Vale,
  • Marcus Silva,
  • Michelle Discacciati,
  • Ilana Polegatto,
  • Julio Teixeira,
  • Luiz Zeferino
Diama Vale
UNICAMP

Corresponding Author:[email protected]

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Marcus Silva
University of Sorocaba
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Michelle Discacciati
State University of Campinas
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Ilana Polegatto
State University of Campinas
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Julio Teixeira
State University of Campinas
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Luiz Zeferino
State University of Campinas
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Abstract

Objective: To report a modelling study using local health care costs and epidemiological inputs from a population-based program to access the cost-effectiveness of adopting hrHPV test. Design: A cost-effectiveness analysis based on a microsimulation dynamic Markov model. Data and costs were based on data from the local setting and literature review. Setting: Indaiatuba, Brazil. The city has adopted the hrHPV test replacing cytology since 2017. Sample: After calibrating the model, one million women were simulated in hypothetical cohorts. Methods: Three strategies were tested: cytology to women aged 25 to 64 every three years; hrHPV test to women 25-64 every five years; cytology to women 25-29 years every 3 years and hrHPV test to women 30-64 every five years (hybrid strategy). Main outcome measure: Quality-adjusted life-years (QALY), assessed by the Incremental Cost-Effectiveness Ratio (ICER). Results: The hrHPV testing and the hybrid strategy were the dominant strategies. Costs were lower and provided a more effective option at a negative incremental ratio of US$ 37.87 for the hybrid strategy, and negative US$ 6.16 for the HPV strategy per QALY gained. Reduction on treatment costs would influence a reduction in ICER, and an increase in the costs of the hrHPV test would increase ICER. Conclusions: Using population-based data, the switch from cytology to hrHPV testing in the cervical cancer screening program of Indaiatuba is less costly and cost-effective than the old cytology program. Funding: UNICAMP (research project), Indaiatuba City and Roche Diagnostics (program).
14 May 2021Published in PLOS ONE volume 16 issue 5 on pages e0251688. 10.1371/journal.pone.0251688