title: Vaginal self-sampling is a cost-effective way to increase participation in a cervical cancer screening programme: a randomised trial.
abstract: BACKGROUND
  Cervical cancer screening coverage remains insufficient in most countries. Our objective was to assess whether in-home vaginal self-sampling with a dry swab for high-risk human papillomavirus (HR-HPV) testing is effective and cost-effective in increasing participation in cervical cancer screening.
  
  
  METHODS
  In March 2012, 6000 unscreened women aged 30-65 years, living in a French region covered by a screening programme, who had not responded to an initial invitation to have a Pap smear were equally randomised to three groups: 'no intervention'; 'recall', women received a letter to have a Pap smear; and 'self-sampling', women received a self-sampling kit to return to a centralised virology laboratory for PCR-based HPV testing.
  
  
  RESULTS
  Participation was higher in the 'self-sampling' than in the 'no intervention' group (22.5% vs 9.9%, P<0.0001; OR 2.64) and 'recall' group (11.7%, P<0.0001; OR 2.20). In the 'self-sampling' group, 320 used the self-sampling kit; for 44 of these women with positive HR-HPV test results, 40 had the recommended triage Pap smear. The ICER per extra screened woman was 77.8[euro ] and 63.2[euro ] for the 'recall' and 'self-sampling' groups, respectively, relative to the 'no intervention' group.
  
  
  CONCLUSIONS
  Offering an in-home, return-mail kit for vaginal self-sampling with a dry swab is more effective and cost-effective than a recall letter in increasing participation in cervical cancer screening.
authors.affiliation: 1] INSERM, U1153, Paris, France [2] Cancer Screening Department, CHRU de Tours, Tours 37000, France.
authors.forename: K
authors.initials: K
authors.lastname: Haguenoer
authors.affiliation: Cancer Screening Department, CHRU de Tours, Tours 37000, France.
authors.forename: S
authors.initials: S
authors.lastname: Sengchanh
authors.affiliation: 1] Department of Bacteriology and Virology, CHRU de Tours, Tours 37000, France [2] Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours 37000, France [3] INSERM U966, Tours 37000, France.
authors.forename: C
authors.initials: C
authors.lastname: Gaudy-Graffin
authors.affiliation: Cancer Screening Department, CHRU de Tours, Tours 37000, France.
authors.forename: J
authors.initials: J
authors.lastname: Boyard
authors.affiliation: Medico-Economic Evaluation Unit, CHRU de Tours, Tours 37000, France.
authors.forename: R
authors.initials: R
authors.lastname: Fontenay
authors.affiliation: 1] Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours 37000, France [2] Department of Gynaecology and Obstetrics, CHRU de Tours, Tours 37000, France.
authors.forename: H
authors.initials: H
authors.lastname: Marret
authors.affiliation: 1] Department of Bacteriology and Virology, CHRU de Tours, Tours 37000, France [2] Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours 37000, France [3] INSERM U966, Tours 37000, France.
authors.forename: A
authors.initials: A
authors.lastname: Goudeau
authors.affiliation: Virology Laboratory, Inter-Regional Health Institute, Tours 37000, France.
authors.forename: N
authors.initials: N
authors.lastname: Pigneaux de Laroche
authors.affiliation: 1] Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours 37000, France [2] Medico-Economic Evaluation Unit, CHRU de Tours, Tours 37000, France [3] Université François-Rabelais, Équipe émergente de recherche Éducation, Éthique, Santé, Tours, France.
authors.forename: E
authors.initials: E
authors.lastname: Rusch
authors.affiliation: 1] INSERM, U1153, Paris, France [2] Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours 37000, France [3] CHRU de Tours, INSERM CIC1415, Tours 37000, France.
authors.forename: B
authors.initials: B
authors.lastname: Giraudeau
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010358:Patient Participation; D011933:Reagent Kits, Diagnostic; D002583:Uterine Cervical Neoplasms; D014626:Vaginal Smears / Q000191:economics / Q000379:methods*
chemical_list: D011933:Reagent Kits, Diagnostic