PONE-D-21-05775

Is the HPV-test more cost-effective than cytology in cervical cancer screening? An economic analysis from a middle-income country

PLOS ONE

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Academic Editor

PLOS ONE

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"This project is funded by UNICAMP (Women's Hospital), Indaiatuba City (SUS), and Roche Diagnostics, as detailed below: This study proposal (screening program implementation and cost-effectiveness analyses) was designed by researchers from UNICAMP and introduced by the Indaiatuba City Hall. Both UNICAMP and the municipality use the existing and functioning structure to place the new screening program and carry out the proposed study at no additional cost. The supplies and equipment required to perform HPV testing (for one round in five years), computer system development support, two lab technicians, and a screening program coordinator are provided or supported by Roche Diagnostics. Roche Diagnostics supports an external statistician defined by researchers to develop a model and perform the planned cost-effectiveness analyses. There are no planned compensations or cash transfers provided to any institution or researchers stated in the parties' cooperation agreement."

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Reviewers' comments:

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Comments to the Author

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Reviewer #1: Yes

Reviewer #2: Partly

Reviewer #3: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

Reviewer #2: I Don't Know

Reviewer #3: Yes

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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5. Review Comments to the Author

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Reviewer #1: Thank you for the opportunity to read this paper. This issue is of great interest for implementation in a country like Brazil. The cost-effectiveness analysis of screening strategies of the most prevalent gynecological cancer in Brazil is extremely relevant.

I would like to express some comments and make some questions. Their are small corrections and suggestions for the text.

1) The test used includes the analysis of which hrHPV? Only 16/18? In the different states of Brazil, we know that the prevalence of HPV types is different and, depending on the analysis, it could eventually impair the analysis.

2) Line 93: I believe that you meant from 30 years old and not until 30 years old.

3) The sentence: "HPV vaccination in Brazil started in 2014, and the first cohort of vaccinated girls will not reach the age of screening until 2026." is out of context in my point of view.

4) The paragraph of line 100 could be omitted and references should only be cited when necessary.

5) In several parts of the text, the FIGO classification is written in Arabic numbers and I believe that Roman numbers would be better even to avoid confusing the reading of CIN 2/3.

6) In line 160 there is an extra comma.

7) In the paragraph of line 166, you mentioned that QUALY is a two-dimensional measure and that it varies between zero and one. Based on this afirmation, could you better explain the data in Table 3, please?

8) Line 229, it was not clear which was the value of willingness to pay for the new proposition.

9) In your opinion, the hrHPV test is the best strategy for Brazil?

I wait for your considerations. Thank you so much.

Reviewer #2: Dear authors,

I think you need to clarify deeply the clinically validated HPV assays that you used. Moreover, a clear and sound explanation with results/facts from the population studied about the effectiveness/detection of precursor lesions/ difference in morbidity and mortality in support of HPV testing.

Data should be made available.

The cost-effectiveness should be made obvious.

Reviewer #3: In this article, the authors discussed screening methods for precancerous lesions of cervical cancer. In particular, They were considering cost-effectiveness in low-income and middle-income countries.

I think it is very informative and interesting. It is well accepted without any particular indication. I think it is suitable and acceptable for this journal.

I don't have much to point out, so I don't feel the need for correction. The strengths and limitations are also well considered.

It's close to what has already been reported, but I think it's a great treatise that reflects the realities of the region rather than novelty.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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Is the HPV-test more cost-effective than cytology in cervical cancer screening? An economic analysis from a middle-income country

PONE-D-21-05775R1

Dear Dr. Vale,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Luca Giannella

Academic Editor

PLOS ONE

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