{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T03:46:59Z","timestamp":1779940019598,"version":"3.53.1"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2021,5,14]],"date-time":"2021-05-14T00:00:00Z","timestamp":1620950400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006416","name":"Unicamp","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006416","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Indaiatuba City"},{"DOI":"10.13039\/100004337","name":"Roche","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004337","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Objective<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>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. The setting was Indaiatuba, Brazil, that has adopted the hrHPV test in place of cytology since 2017. After calibrating the model, one million women were simulated in hypothetical cohorts. Three strategies were tested: cytology to women aged 25 to 64 every three years; hrHPV test to women 25\u201364 every five years; cytology to women 25\u201329 years every three years and hrHPV test to women 30\u201364 every five years (hybrid strategy). Outcomes were Quality-adjusted life-years (QALY) and Incremental Cost-Effectiveness Ratio (ICER).<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>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 decrease in ICER, and an increase in the costs of the hrHPV test would increase ICER.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusions<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0251688","type":"journal-article","created":{"date-parts":[[2021,5,14]],"date-time":"2021-05-14T17:37:46Z","timestamp":1621013866000},"page":"e0251688","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":29,"title":["Is the HPV-test more cost-effective than cytology in cervical cancer screening? An economic analysis from a middle-income country"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2423-0225","authenticated-orcid":true,"given":"Diama Bhadra","family":"Vale","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7186-9075","authenticated-orcid":true,"given":"Marcus Tolentino","family":"Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle Garcia","family":"Discacciati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9469-1460","authenticated-orcid":true,"given":"Ilana","family":"Polegatto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0979-376X","authenticated-orcid":true,"given":"Julio Cesar","family":"Teixeira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luiz Carlos","family":"Zeferino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,5,14]]},"reference":[{"key":"pone.0251688.ref001","doi-asserted-by":"crossref","first-page":"3262","DOI":"10.1016\/j.ejca.2013.04.024","article-title":"Worldwide trends in cervical cancer incidence: impact of screening against changes in disease risk factors","volume":"49","author":"S Vaccarella","year":"2013","journal-title":"Eur J Cancer"},{"key":"pone.0251688.ref002","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1016\/S1470-2045(12)70211-5","article-title":"Global cancer transitions according to the Human Development Index (2008\u20132030): a population-based study","volume":"13","author":"F Bray","year":"2012","journal-title":"The lancet oncology"},{"key":"pone.0251688.ref003","article-title":"Elimination of cervical cancer in low- and middle-income countries: Inequality of access and fragile healthcare systems.","author":"DB Vale","year":"2020","journal-title":"Int J Gynaecol Obstet"},{"key":"pone.0251688.ref004","author":"Arbyn","year":"2008","edition":"2"},{"key":"pone.0251688.ref005","article-title":"Secondary prevention of cervical cancer","author":"P Basu","year":"2017","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"pone.0251688.ref006","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1016\/S0140-6736(13)62218-7","article-title":"Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials","volume":"383","author":"G Ronco","year":"2014","journal-title":"Lancet"},{"key":"pone.0251688.ref007","first-page":"CD008587","article-title":"Cytology versus HPV testing for cervical cancer screening in the general population","volume":"8","author":"G Koliopoulos","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"pone.0251688.ref008","author":"World Health Organization","year":"2013"},{"key":"pone.0251688.ref009","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1097\/CEJ.0000000000000202","article-title":"Present and future of cervical cancer prevention in Spain: a cost-effectiveness analysis","volume":"25","author":"L Georgalis","year":"2016","journal-title":"Eur J Cancer Prev"},{"key":"pone.0251688.ref010","first-page":"1132","article-title":"Moving towards an organized cervical cancer screening: costs and impact","volume":"28","author":"M Diaz","year":"2018","journal-title":"Eur J Public Health"},{"key":"pone.0251688.ref011","article-title":"Cost-effectiveness of HPV-based cervical screening based on first year results in the Netherlands: a modelling study","author":"E Jansen","year":"2020","journal-title":"BJOG"},{"key":"pone.0251688.ref012","doi-asserted-by":"crossref","first-page":"e0151619","DOI":"10.1371\/journal.pone.0151619","article-title":"Effectiveness Modelling and Economic Evaluation of Primary HPV Screening for Cervical Cancer Prevention in New Zealand.","volume":"11","author":"J-B Lew","year":"2016","journal-title":"PLoS One"},{"key":"pone.0251688.ref013","doi-asserted-by":"crossref","first-page":"1571","DOI":"10.1038\/bjc.2012.94","article-title":"Cost-effectiveness of cervical cancer screening with primary human papillomavirus testing in Norway","volume":"106","author":"EA Burger","year":"2012","journal-title":"Br J Cancer"},{"key":"pone.0251688.ref014","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.ygyno.2014.12.022","article-title":"Use of primary high-risk human papillomavirus testing for cervical cancer screening: Interim clinical guidance","volume":"136","author":"WK Huh","year":"2015","journal-title":"Gynecologic Oncology"},{"key":"pone.0251688.ref015","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1186\/s12889-019-6536-4","article-title":"Budget impact analysis of cervical cancer screening in Portugal: comparison of cytology and primary HPV screening strategies","volume":"19","author":"A Pista","year":"2019","journal-title":"BMC Public Health"},{"key":"pone.0251688.ref016","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.ejogrb.2017.03.029","article-title":"A model to evaluate the costs and clinical effectiveness of human papilloma virus screening compared with annual papanicolaou cytology in Germany.","volume":"212","author":"KU Petry","year":"2017","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"pone.0251688.ref017","article-title":"Cervical cancer burden in Latin America and the Caribbean: Where are we?","author":"S Pilleron","year":"2020","journal-title":"Int J Cancer"},{"key":"pone.0251688.ref018","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1186\/s12889-020-08688-4","article-title":"Cervical cancer screening program based on primary DNA-HPV testing in a Brazilian city: a cost-effectiveness study protocol","volume":"20","author":"JC Teixeira","year":"2020","journal-title":"BMC Public Health."},{"key":"pone.0251688.ref019","unstructured":"PNUD Brasil. [cited 19 Nov 2020]. Available: https:\/\/www.br.undp.org\/"},{"key":"pone.0251688.ref020","volume-title":"Diretrizes Brasileiras para o Rastreamento do C\u00e2ncer do Colo do \u00datero 2016\u2014segunda edi\u00e7\u00e3o","author":"Instituto Nacional de C\u00e2ncer","year":"2016"},{"key":"pone.0251688.ref021","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1093\/ajcp\/aqaa012","article-title":"Impact of the Current US Preventive Services Task Force Recommendations for Cervical Cancer Screening in Young Women 21 to 29 Years Old","volume":"153","author":"CP Morris","year":"2020","journal-title":"Am J Clin Pathol"},{"key":"pone.0251688.ref022","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1055\/s-0038-1657754","article-title":"Guidelines for HPV-DNA Testing for Cervical Cancer Screening in Brazil.","volume":"40","author":"LC Zeferino","year":"2018","journal-title":"Rev Bras Ginecol Obstet"},{"key":"pone.0251688.ref023","volume-title":"Secondary Analysis of Electronic Health Records","author":"Springer","year":"2016"},{"key":"pone.0251688.ref024","article-title":"Estat\u00edsticas | Funda\u00e7\u00e3o Seade","author":"F Funda\u00e7\u00e3o SEADE"},{"key":"pone.0251688.ref025","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1093\/aje\/kwu159","article-title":"An updated natural history model of cervical cancer: derivation of model parameters","volume":"180","author":"NG Campos","year":"2014","journal-title":"Am J Epidemiol"},{"key":"pone.0251688.ref026","first-page":"132","article-title":"ASCCP Risk-Based Management Consensus Guidelines","volume":"24","author":"D Egemen","year":"2019","journal-title":"J Low Genit Tract Dis"},{"key":"pone.0251688.ref027","article-title":"Cervical cancer in women under 25 years of age and outside the screening age: Diagnosis profile and long-term outcomes.","author":"JC Teixeira","year":"2020","journal-title":"Int J Gynaecol Obstet"},{"key":"pone.0251688.ref028","first-page":"327","article-title":"Family Health Strategy Coverage in Brazil, according to the National Health Survey, 2013","volume":"21","author":"DC Malta","year":"2016","journal-title":"Cien Saude Colet"},{"key":"pone.0251688.ref029","first-page":"53","article-title":"An\u00e1lise das amostras insatisfat\u00f3rias do exame citopatol\u00f3gico do colo do \u00fatero nas regi\u00f5es brasileiras: um estudo retrospectivo","volume":"9","author":"WA Ribeiro","year":"2018","journal-title":"Revista Pr\u00f3-UniverSUS"},{"key":"pone.0251688.ref030","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1590\/0104-1169.3132.2430","article-title":"Factors related to failure to attend the consultation to receive the results of the Pap smear test","volume":"22","author":"CTM Vasconcelos","year":"2014","journal-title":"Rev Lat Am Enfermagem"},{"key":"pone.0251688.ref031","doi-asserted-by":"crossref","DOI":"10.11606\/T.5.2017.tde-20022018-091434","volume-title":"An\u00e1lise de custo-efetividade de estrat\u00e9gias de rastreamento do c\u00e2ncer do colo do \u00fatero no Brasil","author":"JYK Viscondi","year":"2017"},{"key":"pone.0251688.ref032","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1093\/oxfordjournals.aje.a010166","article-title":"Mathematical model for the natural history of human papillomavirus infection and cervical carcinogenesis","volume":"151","author":"ER Myers","year":"2000","journal-title":"Am J Epidemiol"},{"key":"pone.0251688.ref033","first-page":"174","article-title":"Diretriz metodol\u00f3gica para estudos de avalia\u00e7\u00e3o econ\u00f4mica de tecnologias em sa\u00fade no Brasil","author":"RA Ribeiro","year":"2017","journal-title":"J bras econ sa\u00fade (Impr)."},{"key":"pone.0251688.ref034","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1158\/1940-6207.CAPR-19-0076","article-title":"High-Risk HPV Testing in Primary Screening for Cervical Cancer in the Public Health System, S\u00e3o Paulo, Brazil","volume":"12","author":"JE Levi","year":"2019","journal-title":"Cancer Prev Res (Phila)."},{"key":"pone.0251688.ref035","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1186\/s12955-017-0734-5","article-title":"Health-related quality of life in the Brazilian Amazon: a population-based cross-sectional study","volume":"15","author":"MT Silva","year":"2017","journal-title":"Health Qual Life Outcomes"},{"key":"pone.0251688.ref036","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1093\/jnci\/djh104","article-title":"Projected clinical benefits and cost-effectiveness of a human papillomavirus 16\/18 vaccine","volume":"96","author":"SJ Goldie","year":"2004","journal-title":"J Natl Cancer Inst"},{"key":"pone.0251688.ref037","unstructured":"Brazil, Ministry of Health. SIGTAP\u2014Sistema de Gerenciamento da Tabela de Procedimentos, Medicamentos e OPM do SUS. 2020. Available: http:\/\/sigtap.datasus.gov.br\/tabela-unificada\/app\/sec\/inicio.jsp"},{"key":"pone.0251688.ref038","unstructured":"Brazil, Brazilian Institute of Geography and Statistics. Produto Interno Bruto\u2014PIB | IBGE. [cited 24 Nov 2020]. Available: https:\/\/www.ibge.gov.br\/explica\/pib.php"},{"key":"pone.0251688.ref039","author":"World Health Organization","year":"2020"},{"key":"pone.0251688.ref040","article-title":"Clinical impact and cost-effectiveness of primary cytology versus human papillomavirus testing for cervical cancer screening in England","author":"I Bains","year":"2019","journal-title":"Int J Gynecol Cancer"},{"key":"pone.0251688.ref041","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1186\/s12885-015-1332-8","article-title":"Systematic review of model-based cervical screening evaluations","volume":"15","author":"D Mendes","year":"2015","journal-title":"BMC Cancer"},{"key":"pone.0251688.ref042","first-page":"1","article-title":"Level of human development is associated with cervical cancer stage at diagnosis","author":"DB Vale","year":"2018","journal-title":"J Obstet Gynaecol"},{"key":"pone.0251688.ref043","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/2046-4053-2-35","article-title":"Screening for cervical cancer: a systematic review and meta-analysis","volume":"2","author":"L Peirson","year":"2013","journal-title":"Syst Rev"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0251688","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T22:22:00Z","timestamp":1725056520000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0251688"}},"subtitle":[],"editor":[{"given":"Luca","family":"Giannella","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,5,14]]},"references-count":43,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5,14]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0251688","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,14]]}}}