title: Prevention of cervical cancer in women with ASCUS in the Brazilian Unified National Health System: cost-effectiveness of the molecular biology method for HPV detection.
abstract: This study aimed to assess the performance of PCR as a means of detecting HPV 16/18 compared to the single probe-based PCR for detecting high-risk HPV, and evaluate these methods for detecting cervical intraepithelial neoplasia (CIN) in follow-ups for ASCUS testing. It also compares the costs of cytology, PCR methods, colposcopy and biopsy in the Brazilian Unified National Health System. Of the 81 patients with ASCUS, 41 (50.6%) tested positive for HPV 16/18 in PCR testing and 47 (58.02%) tested positive for high-risk HPV with single probe-based PCR testing. The negative predictive value was 93.75% for HPV 16/18 PCR and 100% for single probe-based PCR in cases that progressed to high-grade CIN. The annual costs of patient referral were the following: R$2,144.52 for referral of patients with ASCUS cytology for colposcopy; R$6,307.44 for referral of patients with ASCUS cytology and PCR positive for HPV 16/18 or colposcopy; R$3,691.80 for referral of patients with ASCUS cytology with single probe-based PCR positive for high-risk HPV. Therefore, cost per user can be reduced by performing single probe-based PCR for high-risk HPV on patients with ASCUS.
authors.affiliation: Instituto de Pesquisa em Oncologia, Universidade Federal do Triângulo Mineiro, Uberaba, Brasil. rosekeila@terra.com.br
authors.forename: Rosekeila Simões
authors.initials: RS
authors.lastname: Nomelini
authors.forename: Patrícia Dias Neto
authors.initials: PD
authors.lastname: Guimarães
authors.forename: Pamela Aparecida
authors.initials: PA
authors.lastname: Candido
authors.forename: Ana Cláudia Camargo
authors.initials: AC
authors.lastname: Campos
authors.forename: Márcia Antoniazi
authors.initials: MA
authors.lastname: Michelin
authors.forename: Eddie Fernando Candido
authors.initials: EF
authors.lastname: Murta
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy / Q000191:economics; D003127:Colposcopy / Q000191:economics; D003362:Cost-Benefit Analysis; D005260:Female; D052162:Human papillomavirus 16 / Q000235:genetics / Q000302:isolation & purification*; D052161:Human papillomavirus 18 / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000821:virology; D016133:Polymerase Chain Reaction / Q000191:economics; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000821:virology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000517:prevention & control* / Q000821:virology; D014626:Vaginal Smears / Q000191:economics; D055815:Young Adult