Reviewer’s report
Title: 
COMPARATIVE COST ANALYSIS OF CERVICAL CANCER
SCREENING PROGRAMME BASED ON MOLECULAR DETECTION OF
HPV IN SPAIN
Version: 
3 
Date: 
11 Apr 2021
Reviewer's report:
Dear Editor 
Thank you to give me the opportunity to review the manuscript entitled
(COMPARATIVE COST ANALYSIS OF CERVICAL CANCER SCREENING
PROGRAMME BASED ON MOLECULAR DETECTION OF HPV IN
SPAIN).
The study was aimed to estimate the total costs of a cervical cancer screening
(CCS) with a primary HPV test based on the detection of mRNA compared to
DNA in women aged 35-65 years for the National Health System. Authors
concluded that assuming that 70% of women from 35-65 years attend the CCS
programme, the cost of screening up to the first colposcopy using Aptima HPV
Assay (AHPV) would provide cost savings of up to €41.9 million versus DNA
tests in Spain.
The authors used informative clear title with structured abstract. 
In the introduction, they highlighted the magnitude of the problem (as a primary
screening 
HPV tests, starting at age 30, could improve 60-70% of increased protection
against cervical cancer as compared to cytology-based screening programme). In
addition, they explained why their study was designed (there are several
validated HPV tests, available for primary screening, and according to clinical
evidence, the Aptima HPV Assay (AHPV), has shown to have the same cross-
sectional and longitudinal sensitivity but higher specificity than DNA HPV tests
for detecting HSIL/CIN2+, when used as a primary screening test. Due to their
higher specificity, this test can reduce false-positive results, avoiding unneeded
anxiety for women, overdiagnosis and overtreatment and therefore leading to
saving costs for health systems).
The methodology section is clear.
In the discussion section, authors compared their findings by other finding
(Sauter JL et al., etc.).
They mentioned how they addressed any potential bias. They mentioned the
strength of their study. Also, they mentioned the limitations of their study and
future suggested development of epidemiological studies.
They reached clear conclusion reflecting their results and they used relevant
references.
The manuscript can be accepted for publication without suggested correction or
changes from y side. 
Regards 
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
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Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes