title: Cost analysis of different cervical cancer screening strategies in Mexico.
abstract: OBJECTIVE
  To compare the costs and number of undetected cases of four cervical cancer screening strategies (CCSS) in Mexico.
  
  
  METHODS
  We estimated the costs and outcomes of the following CCSS: a) conventional Papanicolaou smear (Pap) alone; b) high-risk human papilloma virus testing (HR-HPV) as primary screening with Pap as reflex triage; c) HR-HPV as primary screening with HPV-16/18 typing, liquid-based cytology (LBC) and immunostaining for p16/Ki67 testing as reflex triage, and d) co-testing with HR-HPV and LBC with HPV-16/18 typing and immunostaining for p16/Ki67 as reflex triage. The outcome of interest was high-grade cervical lesions or cervical cancer.
  
  
  RESULTS
  HR-HPV testing, HPV typing, LBC testing and immunostaining is the best alternative because it is the least expensive option with an acceptable number of missed cases.
  
  
  CONCLUSIONS
  The opportunity costs of a poor quality CCSS is many false negatives. Combining multiple tests may be a more cost-effective way to screen for cervical cancer in Mexico.
authors.affiliation: Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, México.
authors.forename: Christyn M
authors.initials: CM
authors.lastname: Beal
authors.affiliation: Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, México.
authors.forename: Jorge
authors.initials: J
authors.lastname: Salmerón
authors.affiliation: Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, México.
authors.forename: Yvonne N
authors.initials: YN
authors.lastname: Flores
authors.affiliation: Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, México.
authors.forename: Leticia
authors.initials: L
authors.lastname: Torres
authors.affiliation: Unidad de Investigación Epidemiológica y en Sistemas de Salud, Área de Envejecimiento, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, Distrito Federal, México.
authors.forename: Víctor
authors.initials: V
authors.lastname: Granados-García
authors.affiliation: Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Ellen
authors.initials: E
authors.lastname: Dugan
authors.affiliation: Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Lazcano-Ponce
mesh_terms: D003127:Colposcopy / Q000191:economics / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D055088:Early Detection of Cancer / Q000191:economics*; D005260:Female; D061809:Human Papillomavirus DNA Tests / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D052162:Human papillomavirus 16 / Q000302:isolation & purification; D052161:Human papillomavirus 18 / Q000302:isolation & purification; D006801:Humans; D007150:Immunohistochemistry / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D008800:Mexico / Q000453:epidemiology; D065006:Papanicolaou Test / Q000191:economics* / Q000706:statistics & numerical data; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000821:virology; D012680:Sensitivity and Specificity; D014218:Triage; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology