Cost-Effectiveness of HPV Self-Testing Options for Cervical Cancer Screening

Area of Science:

• Public Health
• Health Economics
• Gynecologic Oncology

Background:

• Mailed human papillomavirus (HPV) self-sampling kits increase cervical cancer screening in underscreened populations and can be cost-effective.
• Previous cost-effectiveness evaluations have not comprehensively assessed this strategy across diverse screening histories.

Purpose of the Study:

• To conduct an economic evaluation, including cost-effectiveness and budget impact analyses, of mailed HPV self-sampling kits.
• To assess the strategy's value among individuals with adherent, overdue, or unknown cervical cancer screening histories within a US healthcare system.

Main Methods:

• A randomized clinical trial (RCT) informed a cost-effectiveness analysis (CEA) and budget impact analysis (BIA).
• Intervention costs were calculated from healthcare system and Medicare perspectives.
• Participants included 31,355 female members aged 30-64 years, randomized by screening history (adherent, overdue, unknown).

Main Results:

• Direct mailing of HPV kits was the most effective and cost-saving strategy for screening-adherent and overdue individuals.
• For overdue individuals, direct mailing generated additional screens at a cost ranging from -$19 (cost-saving) to $63.
• For individuals with unknown screening history, an opt-in approach generally dominated usual care, proving more effective and cost-saving.

Conclusions:

• Directly mailing HPV self-sampling kits is an economically dominant strategy for screening-adherent and overdue populations.
• The program's costs demonstrated rapid decline over a 4-year period.
• Mailed HPV kits represent an effective, efficient, and affordable outreach strategy for cervical cancer screening.