OBJECTIVES: To estimate the cost-effectiveness of the screening strategy with the molecular test with genotyping 16/18 (mHPV) compared to conventional cytology (CC) for the detection of HPV infection in Chile.

METHODS: Model-based cost-effectiveness study to compare mHPV at three different intervals, five, four and three years, with cC every three years. A 40 years’ time horizon and a discount rate of 3% for costs and outcomes were considered from the perspective of the Chilean public health system. We used a decision tree to model the diagnostic phase, articulated with a Markov model to characterize the natural evolution of the disease. Sensitivity and specificity of both tests were obtained from the literature. Costs were expressed in USD as of June 2021 and outcomes in quality-adjusted life years (QALYs). Deterministic and probabilistic sensitivity analysis was performed to explore decision uncertainty.

RESULTS: The mHPV strategy compared to CC, both every three years, was cost-effective for the Chilean system (ICER of $5,859/QALY). If mHPV was applied every 5 years compared with the CC every 3 years, our results showed lower costs but also lower effectiveness (ICER $5,918/QALY), i.e. above the threshold in the south-west quadrant of the cost-effectiveness plane. Finally, if mHPV was implemented every 4 years, then mHPV dominates CC (ICER $-3,927/QALY). This is explained because prolonging the screening interval from 3 to 4, cost decreases with no significant loss of cases.

CONCLUSIONS: Although the mHPV every 3 years is a cost-effective strategy for Chile, the screening strategy every 4 years is the most preferred alternative because it dominates CC.