Cost-utility of screening with liquid cytology or p16/Ki67 dual stain in women identified in cervical cancer triage with non 16/18 HR-HPV.

OBJECTIVES

To perform a cost-utility analysis of the p16/Ki67 dual stain compared to liquid cytology (LC) in the screening of women aged 25-60 years with high-risk papillomavirus (HR-HPV) non 16/18, from the perspective of the Sistema Único de Saúde (SUS) of Brazil.

METHODS

A Markov-coupled decision tree cost-utility analysis model was developed for the follow-up of a hypothetical cohort of 1,000 women in the age group, in health states that simulated the natural progression of cervical cancer. The time horizon was lifetime with a discount rate of 5 percent for costs and benefits. To survey the resources used for the procedures involved, the recommendations of the Brazilian Guidelines for Cervical Cancer Screening were considered. Most of the cost data were obtained from SUS administrative and public databases. Deterministic and probabilistic sensitivity analyses were carried out.

RESULTS

Screening with p16/Ki67 outperformed LC, resulting in an incremental gain of 2.5 quality-adjusted life years (QALYs) and an incremental cost-effectiveness ratio of R$31.40/QALY (range R$12.98-62.90/QALY), well below the reference value of R$40,000/QALY.

CONCLUSIONS

The p16/Ki67 test proved to be cost-effective in screening women with non 16/18 HR-HPV. The results can help Brazilian managers plan and make decisions about incorporating technologies for triage considering the use of HPV tests in cervical cancer screening.