Two self-sampling strategies for HPV primary cervical cancer screening compared with clinician-collected sampling: an economic evaluation
Objective To compare the costs and effects of three sampling strategies for human papillomavirus (HPV) primary screening.Design Cost-consequence analysis from a health system perspective using a deterministic decision tree model.Setting England.Participants A cohort of 10 000 women aged 25–65 years...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/6/e068940.full |
| _version_ | 1797749012471742464 |
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| author | Emma J Crosbie Alex Sargent Katy Turner Elisabeth J Adams Susie Huntington Verena Schneider Krishnan Puri Sudhir |
| author_facet | Emma J Crosbie Alex Sargent Katy Turner Elisabeth J Adams Susie Huntington Verena Schneider Krishnan Puri Sudhir |
| author_sort | Emma J Crosbie |
| collection | DOAJ |
| description | Objective To compare the costs and effects of three sampling strategies for human papillomavirus (HPV) primary screening.Design Cost-consequence analysis from a health system perspective using a deterministic decision tree model.Setting England.Participants A cohort of 10 000 women aged 25–65 years eligible for the National Health Service Cervical Screening Programme (NHSCSP).Methods The model was based on the NHSCSP HPV primary screening pathway and adapted for self-sampling. It used a 3-year cycle: routine screening (year 1) and recall screening (years 2/3). Parameter inputs were informed using published studies, NHSCSP reports and input from experts and manufacturers. Costs were from 2020/2021, British pound sterling (£).Interventions Three sampling strategies were implemented: (1) routine clinician-collected cervical sample, (2) self-collected first-void (FV) urine, (3) self-collected vaginal swab. The hypothetical self-sampling strategies involved mailing women a sampling kit.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 £56.81 for clinician-collected cervical sampling, £38.57 for FV urine self-sampling and £40.37 for vaginal self-sampling. In deterministic sensitivity analysis, 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 £19.2 million (FV urine) or £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. |
| first_indexed | 2024-03-12T16:13:03Z |
| format | Article |
| id | doaj.art-0138e67e71ad4dd9bb4297b3038febad |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-03-12T16:13:03Z |
| publishDate | 2023-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-0138e67e71ad4dd9bb4297b3038febad2023-08-09T08:20:07ZengBMJ Publishing GroupBMJ Open2044-60552023-06-0113610.1136/bmjopen-2022-068940Two self-sampling strategies for HPV primary cervical cancer screening compared with clinician-collected sampling: an economic evaluationEmma J Crosbie0Alex Sargent1Katy Turner2Elisabeth J Adams3Susie Huntington4Verena Schneider5Krishnan Puri Sudhir6Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UKCytology Department, Clinical Sciences Centre, Manchester University NHS Foundation Trust, Manchester, UKAquarius Population Health, London, UKAquarius Population Health, London, UKAquarius Population Health, London, UKAquarius Population Health, London, UKAquarius Population Health, London, UKObjective To compare the costs and effects of three sampling strategies for human papillomavirus (HPV) primary screening.Design Cost-consequence analysis from a health system perspective using a deterministic decision tree model.Setting England.Participants A cohort of 10 000 women aged 25–65 years eligible for the National Health Service Cervical Screening Programme (NHSCSP).Methods The model was based on the NHSCSP HPV primary screening pathway and adapted for self-sampling. It used a 3-year cycle: routine screening (year 1) and recall screening (years 2/3). Parameter inputs were informed using published studies, NHSCSP reports and input from experts and manufacturers. Costs were from 2020/2021, British pound sterling (£).Interventions Three sampling strategies were implemented: (1) routine clinician-collected cervical sample, (2) self-collected first-void (FV) urine, (3) self-collected vaginal swab. The hypothetical self-sampling strategies involved mailing women a sampling kit.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 £56.81 for clinician-collected cervical sampling, £38.57 for FV urine self-sampling and £40.37 for vaginal self-sampling. In deterministic sensitivity analysis, 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 £19.2 million (FV urine) or £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.https://bmjopen.bmj.com/content/13/6/e068940.full |
| spellingShingle | Emma J Crosbie Alex Sargent Katy Turner Elisabeth J Adams Susie Huntington Verena Schneider Krishnan Puri Sudhir Two self-sampling strategies for HPV primary cervical cancer screening compared with clinician-collected sampling: an economic evaluation BMJ Open |
| title | Two self-sampling strategies for HPV primary cervical cancer screening compared with clinician-collected sampling: an economic evaluation |
| title_full | Two self-sampling strategies for HPV primary cervical cancer screening compared with clinician-collected sampling: an economic evaluation |
| title_fullStr | Two self-sampling strategies for HPV primary cervical cancer screening compared with clinician-collected sampling: an economic evaluation |
| title_full_unstemmed | Two self-sampling strategies for HPV primary cervical cancer screening compared with clinician-collected sampling: an economic evaluation |
| title_short | Two self-sampling strategies for HPV primary cervical cancer screening compared with clinician-collected sampling: an economic evaluation |
| title_sort | two self sampling strategies for hpv primary cervical cancer screening compared with clinician collected sampling an economic evaluation |
| url | https://bmjopen.bmj.com/content/13/6/e068940.full |
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