The Cost-Effectiveness of Cervical Self-Sampling to Improve Routine Cervical Cancer Screening: The Importance of Respondent Screening History and Compliance.
Human papillomavirus (HPV) testing allows women to self-collect cervico-vaginal cells at home (i.e., self-sampling). Using primary data from a randomized pilot study, we evaluated the long-term consequences and cost-effectiveness of using self-sampling to improve participation to routine cervical cancer screening in Norway.



We compared a strategy reflecting screening participation (using reminder letters) to strategies that involved mailing self-sampling device kits to women noncompliant to screening within a 5- or 10-year period under two scenarios: (A) self-sampling respondents had moderate under-screening histories, or (B) respondents to self-sampling had moderate and severe under-screening histories. Model outcomes included quality-adjusted life-years (QALY) and lifetime costs. The "most cost-effective" strategy was identified as the strategy just below $100,000 per QALY gained.



Mailing self-sampling device kits to all women noncompliant to screening within a 5- or 10-year period can be more effective and less costly than the current reminder letter policy; however, the optimal self-sampling strategy was dependent on the profile of self-sampling respondents. For example, "10-yearly self-sampling" is preferred ($95,500 per QALY gained) if "5-yearly self-sampling" could only attract moderate under-screeners; however, "5-yearly self-sampling" is preferred if this strategy could additionally attract severe under-screeners.



Targeted self-sampling of noncompliers likely represents good value-for-money; however, the preferred strategy is contingent on the screening histories and compliance of respondents.



The magnitude of the health benefit and optimal self-sampling strategy is dependent on the profile and behavior of respondents. Health authorities should understand these factors prior to selecting and implementing a self-sampling policy. Cancer Epidemiol Biomarkers Prev; 26(1); 95-103. ©2016 AACR.
Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. eburger@hsph.harvard.edu.|Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
Emily A
EA
Burger
Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Stephen
S
Sy
Cancer Registry of Norway, Oslo, Norway.
Mari
M
Nygård
Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Jane J
JJ
Kim
D000328:Adult; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics* / Q000379:methods; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000379:methods; D008875:Middle Aged; D009664:Norway; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000453:epidemiology; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010865:Pilot Projects; D015397:Program Evaluation; D058996:Quality Improvement; D019057:Quality-Adjusted Life Years; D016353:Self-Examination / Q000191:economics / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control* / Q000821:virology; D014626:Vaginal Smears / Q000379:methods