Avaliação comparativa dos custos de rastreamento do câncer de colo uterino segundo as diretrizes do Ministério da Saúde e da Organização Mundial de Saúde para o município do Rio de Janeiro

Abstract

Cervical cancer is a public health issue and the fourth leading cause of female deaths in Brazil, with approximately 16,000 new cases and 6,000 deaths annually. The Ministry of Health currently recommends cytology-based screening every three years. In contrast, the World Health Organization (WHO), which launched a new protocol in 2020, proposes molecular testing for HPV, which can be collected by a healthcare professional or through self-sampling, with a periodicity of five or ten years. This protocol change motivated the present investigation to analyze its financial advantage compared to the national protocol and current practices in the city of Rio de Janeiro. For the methodology, four analysis groups were created: one that evaluated the number of exams performed between 2005 and 2019, and three others that estimated the ideal number of screenings for the same period based on the different protocols. Costs were calculated by considering the type of test, frequency, materials, and labor. The results showed that an estimated 11,901,201 Pap tests would have been necessary, but only 3,530,126 were effectively performed. The actual screening cost reached R$ 93,336,531.44, while the ideal cost, according to the Ministry of Health, would be R$ 317,642,307.32. The WHO protocol, with a 5-year interval, presented a cost of R$ 587,176,534.12 (with a professional) and R$ 545,735,329.26 (with self-sampling). For the 10-year interval, the costs were R$ 388,298,367.40 (with a professional) and R$ 360,893,402.70 (with self-sampling). In conclusion, the number of cytology tests performed was significantly lower than estimated, which suggests the need for a revision of the Ministry of Health's protocol. Furthermore, although the initial cost of the WHO protocol is higher than that of the Ministry of Health, the study considers its adoption to be financially advantageous in the long term, as the HPV-DNA test is more effective and can result in a reduction of subsequent treatment costs.