{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T17:24:46Z","timestamp":1781285086812,"version":"3.54.1"},"reference-count":56,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004337","name":"Roche","doi-asserted-by":"publisher","award":["NA"],"award-info":[{"award-number":["NA"]}],"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:p>Testing for high-risk human papillomavirus with genotyping for types 16 and 18 (HPV16\/18) and triage by p16\/Ki-67 dual-stain immunocytochemistry improves diagnostic performance in cervical cancer screening. We estimated the cost-effectiveness of HPV DNA\u2013based primary screening strategies that detect high-risk genotypes every 5 years with either reflex cytology (hrHPV\u2013Pap-5) or reflex dual stain (CINtec\u00ae PLUS, Roche; hereafter hrHPV\u2013CINtec-5) versus cytology every 3 years (SoC (PAP-3)) among women aged 25\u201364 years, from the Chilean public healthcare perspective. A state-transition microsimulation reflected the natural history of cervical cancer in screening-eligible Chilean women, using local epidemiology and literature-informed inputs. Direct medical costs were obtained from official Chilean sources and converted to USD (1 USD\u2009=\u2009938 CLP). Deterministic and probabilistic sensitivity analyses were conducted; a 30\u201364 years initiation scenario was also evaluated. Both high-risk HPV DNA-based strategies were more effective and cost-saving than SoC (PAP-3). In the 25\u201364 base case, hrHPV\u2013CINtec-5 yielded the greatest health gain (13,003 incremental Quality-Adjusted Life Year, hereafter QALYs) with $16.65 saved per woman, while hrHPV\u2013Pap-5 saved $32.57 with 12,844 QALYs. Probabilistic sensitivity analysis confirmed dominance (most simulations in the southeast quadrant) and cost-effectiveness acceptability &gt;90% across willingness-to-pay ranges. Deterministic analysis highlighted progression risk from HPV16\/18 and the discount rate as key drivers. Transitioning from PAP-3 to high-risk HPV DNA-based primary screening in Chile is projected to improve health outcomes while reducing costs. Among HPV DNA-based strategies detecting high-risk genotypes evaluated, triage with hrHPV\u2013CINtec-5 provided the largest health gain while remaining cost-saving; hrHPV\u2013Pap-5 maximized cost savings. These findings support modernizing the national screening program.<\/jats:p>","DOI":"10.1371\/journal.pone.0332010","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T18:29:41Z","timestamp":1772648981000},"page":"e0332010","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cost-effectiveness of primary HPV genotyping and dual-stain or cytology reflex testing versus cytology-based screening for cervical cancer in Chile"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6000-0219","authenticated-orcid":true,"given":"Nicolas","family":"Armijo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9564-9512","authenticated-orcid":true,"given":"Manuel A.","family":"Espinoza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1219-1871","authenticated-orcid":true,"given":"Pilar","family":"Contreras-Montiel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Macarena","family":"Vera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8381-2439","authenticated-orcid":true,"given":"Carlos","family":"Balmaceda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"pone.0332010.ref001","article-title":"Global burden of cervical cancer: Current estimates, temporal trend and future projections based on the GLOBOCAN 2022","author":"J Wu","year":"2025","journal-title":"Journal of the National Cancer Center"},{"key":"pone.0332010.ref002","unstructured":"WHO. 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