Cost-Effectiveness of Home-Based Self-Sampling vs Clinician Sampling for Anal Precancer Screening

Area of Science:

• Public Health
• Health Economics
• Oncology

Background:

• Anal cancer screening is crucial for high-risk groups, especially sexual and gender minority (SGM) individuals.
• The cost-effectiveness of home-based anal cancer self-sampling has not been previously evaluated in the U.S. for increasing screening uptake.

Purpose of the Study:

• To assess the cost-effectiveness of home-based anal self-sampling compared to traditional clinic-based screening among SGM individuals.

Main Methods:

• An economic evaluation utilizing data from a randomized clinical trial comparing home-based self-sampling to clinic-based screening.
• Inclusion of societal and healthcare payer perspectives, incorporating trial costs, Medicare reimbursement, and participant-reported travel/time costs.
• Analysis of incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves (CEACs) with bootstrap estimation.

Main Results:

• Home-based screening demonstrated higher participation rates (89.2%) compared to clinic-based screening (74.2%).
• The ICER per additional screened participant was $25.19 (societal perspective) and $132.36 (payer perspective).
• Home-based screening showed a high probability of cost-effectiveness across various willingness-to-pay thresholds, particularly from a societal viewpoint.

Conclusions:

• Home-based anal cancer screening is a cost-effective strategy for enhancing screening uptake in SGM populations.
• This method presents a valuable and efficient tool for expanding anal cancer screening coverage and potentially reducing disparities.