Cost-effectiveness studies of HPV self-sampling: A systematic review

Area of Science:

• Public Health
• Health Economics
• Gynecologic Oncology

Background:

• Cervical cancer screening participation remains suboptimal globally.
• Human papillomavirus self-sampling (HPV-SS) offers a potential solution to overcome access barriers.
• Understanding the economic impact of HPV-SS is crucial for successful implementation.

Purpose of the Study:

• To systematically review and synthesize findings from economic evaluations of HPV-SS programs.
• To assess the cost-effectiveness of HPV-SS compared to standard screening methods.
• To identify factors influencing HPV-SS cost-effectiveness and highlight knowledge gaps.

Main Methods:

• Systematic review following PRISMA guidelines.
• Searched online databases for cost and cost-effectiveness studies of HPV-SS published up to June 12, 2019.
• Included studies using economic models comparing HPV-SS to standard-of-care, with data extraction and verification by two reviewers.

Main Results:

• 14 out of 16 eligible studies reported HPV-SS as a cost-effective strategy.
• Increased screening attendance was the primary driver of HPV-SS cost-effectiveness.
• Lower HPV-SS material/testing costs, higher sensitivity, and longer underscreening duration also improved cost-effectiveness.

Conclusions:

• HPV-SS is generally a cost-effective approach to enhance cervical cancer screening.
• Programmatic success hinges on maximizing screening attendance and optimizing testing costs.
• Further research is needed on HPV-SS cost-effectiveness in low- and middle-income countries and with new triage strategies.