An economic evaluation of two self-sampling strategies for HPV primary cervical cancer screening compared with clinician-collected sampling

Abstract

Objective: To compare the cost and effects of three sampling strategies for human papillomavirus (HPV) primary screening. Design: Cost-consequence analysis using a decision tree in Excel. Setting: England. Participants: A cohort of 10,000 women age 25 to 65 eligible for the NHS Cervical Screening Programme (NHSCSP) (Box 1). Methods: The model was informed by the NHSCSP HPV primary screening pathway and adapted for self-sampling. It used a 3-year recall cycle with routine screening in year 1 and recall screening in years 2/3. Parameters were obtained from published studies, manufacturers, NHSCSP reports, and input from experts. Interventions: Three sampling strategies were: 1) routine clinician-collected cervical sample, 2) self-collected first-void (FV) urine; 3) self-collected vaginal swab. The hypothetical self-sampling strategies involved women being mailed a sampling kit at home. 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 GBP 56.81 for clinician-collected cervical sampling, GBP 38.57 for FV urine self-sampling, and GBP 40.37 for vaginal self-sampling. In deterministic sensitivity analysis (DSA), 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 GBP 19.2 million (FV urine) or GBP 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.

A comparison of the carbon footprint of alternative sampling approaches for cervical screening in the UK: A descriptive study

“…We compare both urine and vaginal self‐sampling methods, which are approaching readiness for implementation in real‐time, against our current standard of care. Our data therefore complement efficacy and health economic studies 59 to support decisions about how we can achieve net zero targets within healthcare.…”

“…Additional screening would create a higher demand for colposcopy services, with up to 13 743 more appointments than in 2022, assuming a 27.6% prevalence of abnormal cytology among high risk HPV‐positive samples and a 74.8% attendance at colposcopy appointments 12,59 . Although an increase in colposcopy services would likely result in additional carbon emissions, there may also be downstream carbon emissions mitigated by cervical cancer cases prevented with these extra screening opportunities.…”

“…Huntington et al. found that the NHS could save £19.2million if FV urine sampling were used, or £16.5million if vaginal self‐sampling were used in the NHSCSP each year 59 . However, the parameters used to inform these hypothetical alternative scenarios are vulnerable to an intention–behaviour gap.…”

“…20 If an additional 45% of the unscreened routinely invited population of 2021-2022 12 were to take up self-sampling, this would increase participation rates to 76% overall and result in 880 356 more people tested in a year. If this increase occurred in combination with a choice of sampling methods with equivalent efficacy as described above, the programme would still save 2405 tonnes of CO 2 e per year, assuming an HPV prevalence of 11.5% 58,59 and an 85% attendance at clinician-collected sampling follow-up for HPVpositive self-samples. The economic benefits of self-sampling have been modelled in a similar scenario, where half of the routinely screened population choose self-sampling and uptake is increased among non-attenders.…”

“…Huntington et al found that the NHS could save £19.2million if FV urine sampling were used, or £16.5million if vaginal self-sampling were used in the NHSCSP each year. 59 However, the parameters used to inform these hypothetical alternative scenarios are vulnerable to an intention-behaviour gap. The uptake of self-sampling was 8% when offered to all people eligible for screening in the Netherlands and it did not increase overall participation rates of the national screening programme, 60 although this is likely to differ between settings.…”