OBJECTIVES: To estimate the cost-effectiveness of the screening strategy with the molecular test with genotyping 16/18 compared to conventional cytology for the detection of human papilloma virus infection in Uruguay.

METHODS: We performed a model-based cost-effectiveness study to compare molecular tests with genotyping 16/18 at three different intervals, in five, four, and three years, with conventional cytology every three years. A lifetime time horizon and a discount rate of 3% for costs and outcomes were considered from the perspective of the Uruguayan public health system. A microsimulation health-state transition model was used to characterize the natural evolution of the disease. Sensitivity and specificity of both tests were obtained from the literature. Costs were expressed in USD dated June 2022 and outcomes in quality-adjusted life years (QALYs). Deterministic and probabilistic sensitivity analyses were performed to explore decision uncertainty.

RESULTS: The results of the study showed that the molecular test with genotyping 16/18 was the most cost-effective alternative. In effect, all comparisons were less costly and more effective with ICERs -$152,243; -$35,159; -$6,747 per additional QALY for every five, four, and three years respectively. However, the molecular test with genotyping 16/18 applied every five years showed the highest incremental health net benefits (0.008481817). Probabilistic sensitivity analysis showed that uncertainty is probably associated with the source of parameters used to populate the epidemiological profile of the simulated patients.

CONCLUSIONS: Although the three comparisons of the molecular test with genotyping 16/18 were dominant strategies for Uruguay, the screening strategy is most preferred every five years because it shows the highest health net benefit for the public health system