Cost-effectiveness analysis of repeated self-sampling for HPV testing in primary cervical screening: a randomized...

Area of Science:

• Gynecology
• Public Health
• Oncology

Background:

• Primary cervical screening is crucial for cancer prevention, with human papillomavirus (HPV) testing recommended.
• HPV testing via self-sampling offers potential for increased population coverage and efficient identification of at-risk women.
• This study evaluates the cost-effectiveness of repeated HPV self-sampling versus Pap smears for detecting cervical intraepithelial neoplasia grade 2 or more (CIN2+).

Purpose of the Study:

• To assess the cost-effectiveness of repeated HPV self-sampling compared to Pap smear cytology in primary cervical screening.
• To determine if HPV self-sampling increases participation rates and detection of CIN2+.
• To compare the efficiency and cost of HPV self-sampling versus traditional Pap smears.

Main Methods:

• A cost-effectiveness analysis (CEA) was conducted using data from a randomized clinical study of 36,390 women aged 30-49 years.
• Participants were randomized into two groups: HPV self-sampling (n=17,997) and midwife-collected Pap smears (n=18,393).
• The study compared participation rates, CIN2+ detection, and costs between the two arms.

Main Results:

• HPV self-sampling resulted in 1633 more women screened and 107 additional histologically diagnosed CIN2+ cases.
• The cost for the HPV self-sampling arm was significantly lower (€229,446) compared to the Pap smear arm (€782,772).
• HPV self-sampling demonstrated a higher detection rate of CIN2+ at a reduced overall cost.

Conclusions:

• Repeated self-sampling for HPV testing is a more cost-effective strategy than midwife-collected Pap smears for primary cervical screening.
• Offering home-based HPV self-sampling can enhance participation and improve the detection of CIN2+.
• HPV self-sampling represents a potentially more efficient and cost-effective alternative to clinic-based cervical screening programs.