Original paper

Cancer Causes & Control

, Volume 22, Issue 2, pp 261-272

Open Access This content is freely available online to anyone, anywhere at any time.

HPV testing for cervical cancer screening appears more cost-effective than Papanicolau cytology in Mexico

  • Yvonne N. FloresAffiliated withUnidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social Email author 
  • , David M. BishaiAffiliated withDepartment of Population, Family, and Reproductive Health, Johns Hopkins University, Bloomberg School of Public Health
  • , Attila LőrinczAffiliated withWolfson Institute of Preventive Medicine, Barts and The London School of Medicine, Queen Mary University of London
  • , Keerti V. ShahAffiliated withDepartment of Molecular Microbiology and Immunology, Johns Hopkins University, Bloomberg School of Public Health
  • , Eduardo Lazcano-PonceAffiliated withCentro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública
  • , Mauricio HernándezAffiliated withSecretaria de Prevención y Promoción de la Salud, Secretaría de Salud
  • , Víctor Granados-GarcíaAffiliated withUnidad de Investigación en Economía de la Salud, Instituto Mexicano del Seguro Social
  • , Ruth PérezAffiliated withDepartamento de Abastecimiento, Instituto Mexicano del Seguro Social, Hospital General Regional No. 1
  • , Jorge SalmerónAffiliated withUnidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social



To determine the incremental costs and effects of different HPV testing strategies, when compared to Papanicolau cytology (Pap), for cervical cancer screening in Mexico.


A cost-effectiveness analysis (CEA) examined the specific costs and health outcomes associated with (1) no screening; (2) only the Pap test; (3) only self-administered HPV; (4) only clinician administered HPV; and (5) clinician administered HPV plus the Pap test. The costs of self- and clinician-HPV testing, as well as with the Pap test, were identified and quantified. Costs were reported in 2008 US dollars. The health outcome associated with these screening strategies was defined as the number of high-grade cervical intraepithelial neoplasia or cervical cancer cases detected. This CEA was performed using the perspective of the Mexican Institute of Social Security (IMSS) in Morelos, Mexico.


Screening women between the ages of 30–80 for cervical cancer using clinical-HPV testing or the combination of clinical-HPV testing, and the Pap is always more cost-effective than using the Pap test alone.


This CEA indicates that HPV testing could be a cost-effective screening alternative for a large health delivery organization such as IMSS. These results may help policy-makers implement HPV testing as part of the IMSS cervical cancer screening program.


Cost-effectiveness Cervical cancer HPV Screening Mexico