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 Costa Rica.

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 two years. A lifetime time horizon and a discount rate of 3.5% for costs and outcomes were considered from the perspective of the Costa Rican 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 September 2022 and outcomes in quality-adjusted life years (QALYs). Deterministic and probabilistic sensitivity analyses were performed to explore decision uncertainty.

RESULTS: The molecular tests with genotyping 16/18 every three and four year were less costly and more effective with ICERs -$41,103 and -$7,217 per additional QALY respectively. Whereas in every five years compared with conventional cytology every two years, our results showed both incremental costs and QALY negative (ICER $100,228 per additional QALY). However, the molecular test with genotyping 16/18 applied every four years showed the highest incremental health net benefits (0.012206). 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 cost-effective strategies for Costa Rica, the screening strategy is most preferred every four years because it shows the highest health net benefit for the public health system.