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Two self-sampling strategies for HPV primary cervical cancer screening compared with clinician-collected sampling: an
Susie Huntington1, Krishnan Puri Sudhir2, Verena Schneider2
1Aquarius Population Health, London, UK susie.huntington@aquariusph.com.
Objective:
To compare the costs and effects of three sampling strategies for human papillomavirus (HPV) primary screening.
Design:
Cost-consequence analysis from a health system perspective using a deterministic decision tree model.
Setting:
England.
Participants:
A cohort of 10 000 women aged 25-65 years eligible for the National Health Service Cervical Screening Programme (NHSCSP).
Methods:
The model was based on the NHSCSP HPV primary screening pathway and adapted for self-sampling. It used a 3-year cycle: routine screening (year 1) and recall screening (years 2/3). Parameter inputs were informed using published studies, NHSCSP reports and input from experts and manufacturers. Costs were from 2020/2021, British pound sterling (£).
Interventions:
Three sampling strategies were implemented: (1) routine clinician-collected cervical sample, (2) self-collected first-void (FV) urine, (3) self-collected vaginal swab. The hypothetical self-sampling strategies involved mailing women a sampling kit.
Main Outcome Measures:
Primary outcomes: overall costs (for all screening steps to colposcopy), number of complete screens and cost per complete screen.
Secondary Outcomes:
number of women screened, number of women lost to follow-up, cost per colposcopy and total screening costs for a plausible range of uptake scenarios.
Results:
In the base case, the average cost per complete screen was £56.81 for clinician-collected cervical sampling, £38.57 for FV urine self-sampling and £40.37 for vaginal self-sampling. In deterministic sensitivity analysis, the variables most affecting the average cost per screen were the cost of sample collection for clinician-collected sampling and the cost of laboratory HPV testing for the self-sampling strategies. Scaled to consider routine screening in England, if uptake in non-attenders increased by 15% and 50% of current screeners converted to self-sampling, the NHSCSP would save £19.2 million (FV urine) or £16.5 million (vaginal) per year.
Conclusion:
Self-sampling could provide a less costly alternative to clinician-collected sampling for routine HPV primary screening and offers opportunities to expand the reach of cervical screening to under-screened women.
