Abstract
BackgroundHuman papillomavirus (HPV) testing is recommended in primary cervical screening to improve cancer prevention. An advantage of HPV testing is that it can be performed on self-samples, which could increase population coverage and result in a more efficient strategy to identify women at risk of developing cervical cancer. Our objective was to assess whether repeated self-sampling for HPV testing is cost-effective in comparison with Pap smear cytology for detection of cervical intraepithelial neoplasia grade 2 or more (CIN2+) in increasing participation rate in primary cervical screening.MethodsA cost-effectiveness analysis (CEA) was performed on data from a previously published randomized clinical study including 36,390 women aged 30–49 years. Participants were randomized either to perform repeated self-sampling of vaginal fluid for HPV testing (n = 17,997, HPV self-sampling arm) or to midwife-collected Pap smears for cytological analysis (n = 18,393, Pap smear arm).ResultsSelf-sampling for HPV testing led to 1633 more screened women and 107 more histologically diagnosed CIN2+ at a lower cost vs. midwife-collected Pap smears (€ 229,446 vs. € 782,772).ConclusionsThis study resulted in that repeated self-sampling for HPV testing increased participation and detection of CIN2+ at a lower cost than midwife-collected Pap smears in primary cervical screening. Offering women a home-based self-sampling may therefore be a more cost-effective alternative than clinic-based screening.Trial registrationNot registered since this trial is a secondary analysis of an earlier published study (Gustavsson et al., British journal of cancer. 118:896-904, 2018).
Highlights
Human papillomavirus (HPV) testing is recommended in primary cervical screening to improve cancer prevention
The first aim of this study was to compare the cost-effectiveness of repeated self-sampling for HPV testing with midwife-collected Pap smear cytology based on data from a recent randomized study on primary cervical screening [18]
Cost-effectiveness analysis on primary screening including clinical follow-up The participation rate in cervical screening was significantly higher in the HPV self-sampling arm than in the Pap smear arm (47% vs. 39%, P < 0.001)
Summary
Human papillomavirus (HPV) testing is recommended in primary cervical screening to improve cancer prevention. An advantage of HPV testing is that it can be performed on self-samples, which could increase population coverage and result in a more efficient strategy to identify women at risk of developing cervical cancer. Our objective was to assess whether repeated self-sampling for HPV testing is cost-effective in comparison with Pap smear cytology for detection of cervical intraepithelial neoplasia grade 2 or more (CIN2+) in increasing participation rate in primary cervical screening. Aarnio et al BMC Cancer (2020) 20:645 specificity of HPV testing, cytological testing of HPVpositive samples at primary screening (cytology triage) is recommended. This presents a challenge in how to manage women that are HPV-positive but cytologynegative, since they have an elevated risk of CIN2+ [8]. In a large meta-analysis self-sampling for primary cervical screening was recommended, but only when using PCR-based HPV tests [17]
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