Custo-efetividade da vacina HPV quadrivalente, teste HPV e citologia em meio líquido: revisão integrativa

Abstract

Cervical cancer is one of the most common tumors in female population, being the third most common cancer and the fourth leading cause of cancer death in women. In order to prevent cervical cancer, Brazil developed many prevention and screening strategies, including the insertion of HPV vaccine. In addition, there are two secondary prevention strategies that have not been adopted in Brazil yet, liquid-based cytology and HPV test. Although those methods are not inserted in our Health System reality, it is important to know them. Thus, nurses are a fundamental element in strategies implementation for prevention and early detection of CC, acting mainly in prevention through vaccination and in cervical cancer screening test. The aim of this study is to analyze scientific production about the cost-effectiveness of the HPV vaccine, liquid-based cytology and HPV Test for prevention and detection of precursor lesions of cervical cancer. This is an integrative literature review. A search in April and May of 2018 was performed on the following databases: LILACS, PubMed, Cochrane Library and CINAHL. The inclusion criteria were: to be a complete research article, to be published in Portuguese, English or Spanish languages and to portray the cost-effectiveness of the quadrivalent HPV vaccine, liquid-based cytology and HPV test used in cervical cancer screening. It was not established a temporal criteria. The DECS descriptors used were: Uterine Cervical Neoplasms, Papillomavirus Vaccines, Cost Benefit Analysis and Early Detection of Cancer. And as uncontrolled descriptors: HPV test and liquid-based cytology. The descriptors of the Medical Subject Headings (MeSH) were: Human Papillomavirus DNA Tests; Early Detection of Cancer; Papillomavirus Vaccines and Cost-Benefit Analysis and Liquid-based Cytology as an uncontrolled descriptor. Thirty-four articles were included in this review. Twenty of those articles analyzed the cost-effectiveness of the quadrivalent HPV vaccine in girls. Ten articles evaluated the cost-effectiveness of HPV tests and only 4 analyzed the cost-effectiveness of liquid-based cytology. Thus, it was observed that the methods addressed in this study were considered cost-effective in most of the studies included in this integrative review. Only four studies reported that the vaccine and liquid-based cytology were not cost-effective because of the high price of these methods. Therefore, although this study subject is poor explored, it was possible to update the recommendations of prevention and screening of CC for the PROGYNE protocol.