title: The costs of offering HPV-testing on self-taken samples to non-attendees of cervical screening in Finland.
abstract: BACKGROUND
  Offering self-sampling to non-attendees of cervical screening increases screening attendance.
  
  
  METHODS
  We used observations from two Finnish studies on the use of self-sampling among the non-attendees to estimate in a hypothetical screening population of 100,000 women the possible costs per extra screened woman and costs per extra detected and treated CIN2+ with three intervention strategies; 1) a primary invitation and a reminder letter, 2) a primary invitation and a mailed self-sampling kit and 3) two invitation letters and a self-sampling kit. The program costs were derived from actual performance and costs in the original studies and a national estimate on management costs of HPV related diseases.
  
  
  RESULTS
  The price per extra participant and price per detected and treated CIN2+ lesion was lower with a reminder letter than by self-sampling as a first reminder. When self-sampling was used as a second reminder with a low sampler price and a triage Pap-smear as a follow-up test for HPV-positive women instead of direct colposcopy referral, the eradication of a CIN2+ lesion by self-sampling was not more expensive than in routine screening, and the addition of two reminders to the invitation protocol did not increase the price of an treated CIN2+ lesion in the entire screened population.
  
  
  CONCLUSIONS
  As a first reminder, a reminder letter is most likely a better choice. As second reminder, the higher costs of self-sampling might be compensated by the higher prevalence of CIN2+ in the originally non-attending population.
authors.affiliation: Mass Screening Registry, Finnish Cancer Registry, Unioninkatu 22, FI-00130, Helsinki, Finland. anni.virtanen@cancer.fi.
authors.forename: Anni
authors.initials: A
authors.lastname: Virtanen
authors.affiliation: Mass Screening Registry, Finnish Cancer Registry, Unioninkatu 22, FI-00130, Helsinki, Finland. ahti.anttila@cancer.fi.
authors.forename: Ahti
authors.initials: A
authors.lastname: Anttila
authors.affiliation: Department of Obstetrics and Gynecology, Kätilöopisto Hospital, Helsinki University Central Hospital, Helsinki, Finland. pekka.nieminen@hus.fi.
authors.forename: Pekka
authors.initials: P
authors.lastname: Nieminen
mesh_terms: D000328:Adult; D055088:Early Detection of Cancer / Q000191:economics* / Q000379:methods*; D005260:Female; D005387:Finland; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000379:methods; D008875:Middle Aged; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000175:diagnosis; D011247:Pregnancy; D012648:Self Care / Q000191:economics* / Q000379:methods* / Q000639:trends; D013048:Specimen Handling; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis; D014626:Vaginal Smears / Q000379:methods*