title: HPV testing for cervical cancer screening appears more cost-effective than Papanicolau cytology in Mexico.
abstract: OBJECTIVE
  To determine the incremental costs and effects of different HPV testing strategies, when compared to Papanicolau cytology (Pap), for cervical cancer screening in Mexico.
  
  
  METHODS
  A cost-effectiveness analysis (CEA) examined the specific costs and health outcomes associated with (1) no screening; (2) only the Pap test; (3) only self-administered HPV; (4) only clinician administered HPV; and (5) clinician administered HPV plus the Pap test. The costs of self- and clinician-HPV testing, as well as with the Pap test, were identified and quantified. Costs were reported in 2008 US dollars. The health outcome associated with these screening strategies was defined as the number of high-grade cervical intraepithelial neoplasia or cervical cancer cases detected. This CEA was performed using the perspective of the Mexican Institute of Social Security (IMSS) in Morelos, Mexico.
  
  
  RESULTS
  Screening women between the ages of 30-80 for cervical cancer using clinical-HPV testing or the combination of clinical-HPV testing, and the Pap is always more cost-effective than using the Pap test alone.
  
  
  CONCLUSIONS
  This CEA indicates that HPV testing could be a cost-effective screening alternative for a large health delivery organization such as IMSS. These results may help policy-makers implement HPV testing as part of the IMSS cervical cancer screening program.
authors.affiliation: Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, México. yflores@jhsph.edu
authors.forename: Yvonne N
authors.initials: YN
authors.lastname: Flores
authors.forename: David M
authors.initials: DM
authors.lastname: Bishai
authors.forename: Attila
authors.initials: A
authors.lastname: Lorincz
authors.forename: Keerti V
authors.initials: KV
authors.lastname: Shah
authors.forename: Eduardo
authors.initials: E
authors.lastname: Lazcano-Ponce
authors.forename: Mauricio
authors.initials: M
authors.lastname: Hernández
authors.forename: Víctor
authors.initials: V
authors.lastname: Granados-García
authors.forename: Ruth
authors.initials: R
authors.lastname: Pérez
authors.forename: Jorge
authors.initials: J
authors.lastname: Salmerón
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D003584:Cytological Techniques / Q000191:economics / Q000379:methods; D055088:Early Detection of Cancer / Q000191:economics* / Q000379:methods*; D005260:Female; D006801:Humans; D008800:Mexico; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification* / Q000502:physiology; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000821:virology; D014626:Vaginal Smears / Q000191:economics* / Q000379:methods; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000209:etiology / Q000821:virology