Economic impact of strategies for cervical cancer screening in brazilian primary healthcare system by cost-effectiveness analysis

In Brazil, new strategies aligned with Pan American Health Organization guidelines are being adopted to combat cervical cancer. One approach is screening women every five years using real-time PCR tests to detect oncogenic HPV DNA. Now, screening is performed using conventional cytology in women aged 25 to 64, with triennial tests. The present study used meta-analysis and Markov predictive simulation to analyze the cost-effectiveness of evaluation tests for cervical cancer screening in Unified Health System. The focus is on the real costs paid by the Ministry of Health in comparison with the recommendations of the new Brazilian Guidelines for Screening of this Cancer, considering the real Brazilian scenario. Odds ratio values of real-time PCR for HPV DNA and liquid based cytology were compared and showed that they were statistically similar (p > 0.05). However, performance of conventional cytology was significantly superior to that of others diagnostic methods (p < 0.05). Furthermore, in sensitivity analysis, conventional cytology was significantly superior to real-time PCR for detecting HPV DNA. Total accumulated cost of real-time PCR for detecting HPV DNA was 7.36% greater than that of conventional cytology over 36 months. Total cost of diagnosing all women by real-time PCR for HPV DNA over 36 months would be approximately US$5,050 trillion, which is equivalent to 70,2% of Brazil's gross domestic product in 2024. This study argues that conventional cytology is more cost-effective for the public and could reduce the number of epidemiological indicators of cervical cancer if it is implemented in an organized manner.