Cost-effectiveness analysis of cervical cancer screening strategies in Brazil

Abstract

The cervical cancer screening has been reducing mortality from this cancer in Brazil. Another form of prevention is the immunization against human papillomavirus (HPV) infection. The vaccine will be offered by the National Immunization Program (PNI), starting in 2014. However, the vaccination doesn't replace the cancer screening, since there is only immunization of 9-13 years old girls and protection against 16 and 18 oncogenic types. The vaccination program incorporation interferes with the screening program results because it leads to fewer cases of cancer and precursor lesions. There is now a need to explore new screening strategies, considering also that, besides the Papanicolaou, there are other tests such as liquid cytology and the detection of HPV DNA. Thus, this study will be the first project to evaluate the cost-effectiveness analysis of cervical cancer screening strategies for hypothetical vaccinated and unvaccinated cohorts in Brazil in the perspective of the Unified Health System (SUS) and society. The study will follow 25 years old women until their death, using the decision analysis Markov Model, and will present the incremental cost-effectiveness ratio (ICER). The parameters of these models are estimated from secondary data (literature review, health information systems and population surveys). Partnering with Oncocentro Foundation of São Paulo (FOSP) allow the use of the database with results of cervical cytology (Pap) tests performed in FOSP for construction of epidemiological estimates to be incorporated into the decision model. Univariate, multivariate and probabilistic sensitivity analysis will be conducted to assess the robustness of the results. (AU)