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Cost-Effectiveness of Home-Based Self-Sampling vs Clinician Sampling for Anal Precancer Screening
Haluk Damgacioglu1,2, Timothy L McAuliffe3, Timothy J Ridolfi4
1Department of Public Health Sciences, Medical University of South Carolina, Charleston.
Importance:
Anal cancer screening is recommended for high-risk populations, particularly sexual and gender minority (SGM) individuals. However, the cost-effectiveness of home-based self-sampling in increasing anal cancer screening uptake has not yet been evaluated in the US.
Objective:
To evaluate the cost-effectiveness of home-based anal self-sampling compared with clinic-based screening among SGM individuals.
Design, Setting, And Participants:
This economic evaluation used data from a 2-group randomized clinical trial conducted in Milwaukee, Wisconsin, from January 2020 to August 2022, enrolling SGM individuals aged 25 years or older. Participants were randomized to home-based self-sampling or clinic-based screening. Costs for home-based screening were obtained from the trial, and clinic-based costs were sourced from the Medicare reimbursement schedule. Travel and time costs were derived on the basis of participant self-reports. The analysis was performed between February and October 2025.
Intervention:
Participants in the home-based screening group received self-sampling supplies and instructions, and those in the clinic-based screening group were instructed to visit a clinic for anal cancer screening.
Main Outcomes And Measures:
The primary outcome was the incremental cost-effectiveness ratio (ICER), measured as the additional cost needed to increase screening participation by one person. The 95% CIs for the ICERs were estimated using a bootstrap method with 1000 iterations. Net benefit regression and cost-effectiveness acceptability curves were used to assess the likelihood of cost-effectiveness across different willingness-to-pay (WTP) thresholds.
Results:
The study included 240 SGM individuals (227 with gender identity as a man [95%]; median [IQR] age, 46 [33 to 57] years), of whom 65 (27%) had HIV. The cost per participant was $64.18 for home-based screening and $60.40 for clinic-based screening from a societal perspective, and $61.91 for home-based screening and $42.06 for clinic-based screening from a health care payer perspective. Home-based screening was associated with increased screening participation vs clinic-based screening (107 participants [89.2%] vs 89 participants [74.2%]). The ICER per additional screened participant was $25.19 (95% CI, -$27.66 to $104.60) for the societal perspective and $132.36 (95% CI, $74.54 to $402.20) for the health care payer perspective. Home-based screening had a 49.6% probability of being cost-effective at a WTP of $25, 99.99% at a WTP of $100 (societal perspective), and 90.9% at a WTP of $200 (health care payer perspective). The ICERs for home-based screening compared with clinic-based screening were highly sensitive to screening participation rates.
Conclusions And Relevance:
The findings of this economic analysis suggest that home-based anal cancer screening is a cost-effective approach to increasing screening participation among SGM individuals. Home-based screening may serve as a valuable and efficient tool for expanding screening rates.
