Evaluating the use of different HPV testing strategies, as compared to the PAP, for the detection of cervical cancer in Mexico: Epidemiologic and economic analyses

Background. Cervical cancer (CC) is a serious public health problem worldwide. Human papillomavirus (HPV), a sexually transmitted infection, is recognized as a necessary cause of CC. This recognition has produced interest in the use of HPV testing for CC screening. This research study evaluates the use of HPV testing, as compared to the Pap test, for CC screening.; Methods. An epidemiological analysis was performed to identify risk factors associated with a cervical intraepithelial neoplasia (CIN) 2/3 or CC diagnosis among women who are high-risk HPV positive, as detected by a clinician-collected test. A cost-effectiveness analysis (CEA) was conducted to determine the incremental costs and effects of several HPV testing strategies, as compared to the Pap. A preliminary cost-benefit analysis (CBA) was performed to compare the monetary costs and benefits associated with HPV testing, as compared to the Pap test.; Results. The epidemiological analysis results indicate that increasing age, viral load, and a young age at first sexual intercourse are important risk factors for the development of CIN 2/3 and CC among clinician-HPV positive women. The results of the CEA and CBA indicate that the HPV testing women aged 20–80 is more cost-effective than screening women between the ages of 30–80. This finding was found to be true from the perspective of the Mexican Institute of Social Security (IMSS) and Mexican society. Self-HPV testing for women aged 20–80 is a low cost screening option that can detect up to 71% of CC cases. The clinician-HPV test is more expensive than the self-HPV test, and is able to detect 93% of all CC cases. Finally, the Pap and clinician-HPV test combination is the most expensive screening option, but it identifies 98% of CC cases.; Conclusions. HPV testing is a cost-effective and viable option for the IMSS CC screening program in Morelos, Mexico. HPV testing is more sensitive than the Pap for detecting CIN 2/3 and CC, but it is also less specific. An HPV testing strategy with a triage mechanism that considers factors such as age and viral load may result in a decreased number of colposcopies and an increased cost-effectiveness.