Abstract
Objective:
To compare the costs and number of undetected cases of four cervical cancer screening strategies (CCSS) in Mexico.
Materials and methods:
We estimated the costs and outcomes of the following CCSS: a) conventional Papanicolaou smear (Pap) alone; b) high-risk human papilloma virus testing (HR-HPV) as primary screening with Pap as reflex triage; c) HR-HPV as primary screening with HPV-16/18 typing, liquid-based cytology (LBC) and immunostaining for p16/Ki67 testing as reflex triage, and d) co-testing with HR-HPV and LBC with HPV-16/18 typing and immunostaining for p16/Ki67 as reflex triage. The outcome of interest was high-grade cervical lesions or cervical cancer.
Results:
HR-HPV testing, HPV typing, LBC testing and immunostaining is the best alternative because it is the least expensive option with an acceptable number of missed cases.
Conclusions:
The opportunity costs of a poor quality CCSS is many false negatives. Combining multiple tests may be a more cost-effective way to screen for cervical cancer in Mexico.
MeSH terms
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Colposcopy / economics
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Colposcopy / statistics & numerical data
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Cost-Benefit Analysis
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Costs and Cost Analysis
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Early Detection of Cancer / economics*
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Female
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Human Papillomavirus DNA Tests / economics*
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Human Papillomavirus DNA Tests / methods
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Human Papillomavirus DNA Tests / statistics & numerical data
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Human papillomavirus 16 / isolation & purification
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Human papillomavirus 18 / isolation & purification
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Humans
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Immunohistochemistry / economics*
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Immunohistochemistry / methods
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Immunohistochemistry / statistics & numerical data
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Mexico / epidemiology
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Papanicolaou Test / economics*
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Papanicolaou Test / statistics & numerical data
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Papillomavirus Infections / diagnosis
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Papillomavirus Infections / economics
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Papillomavirus Infections / epidemiology
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Papillomavirus Infections / virology
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Sensitivity and Specificity
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Triage
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Uterine Cervical Dysplasia / diagnosis
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Uterine Cervical Dysplasia / economics
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Uterine Cervical Dysplasia / epidemiology
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Uterine Cervical Neoplasms / diagnosis*
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Uterine Cervical Neoplasms / economics
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Uterine Cervical Neoplasms / epidemiology