gms | German Medical Science

Introduction: Although cervical cancer screening programs are established in most high and upper-middle income countries, many women eligible for screening remain un- or under-screened. Human papillomavirus (HPV) testing by self-sampling (HPV-SS) can potentially increase participation rates. However, HPV-SS is associated with positive and negative clinical consequences as well as with costs. The objective of this study was to conduct a systematic review on studies assessing the effectiveness and cost-effectiveness of a potential HPV-SS implementation into established cervical cancer screening programs.

Methods: Relevant databases (including Medline and Embase) were searched (until 02/2024) for studies investigating the cost effectiveness of HPV-SS in cervical cancer screening in middle- and high-income countries in Europe. The PRISMA guidelines were followed. Cohort studies, randomized controlled trials and decision-analytic modeling studies published in English or German language were included. Key study characteristics (including author/year/country/currency/target population/study type) and outcomes (e.g., incremental cost-effectiveness ratios [ICER]) were extracted and reported into a standardized evidence table. The study quality was assessed using the CHEERS checklist. The original currency was converted to Euro (index year 2023) for cross-country comparison.

Results: Of 612 studies, 27 studies met the inclusion criteria. The included studies comprised 14 model-based cost-effectiveness evaluations and 13 economic evaluations along trials and were primarily conducted in high-income countries. Included studies compared HPV-SS with standard care (e.g., Pap smear/conventional cytology, clinician-collected HPV testing, standard reminder letters to get screened) or no intervention/screening. Only a few studies investigated HPV-SS in all screening-eligible women, most studies investigated HPV-SS in women not attending regular screening. Direct home mailing of the HPV-SS kit was the preferred method to reach women. ICERs were reported as costs per additional screened woman, per additional CIN1/2, or CIN2+ detected or eradicated, per life-year gained (LYG) or per quality-adjusted life-year (QALY) gained. ICERs ranged from 3,800 Euro/QALY for the provision of HPV-SS-based screening for non-participants (Netherlands) to 30,000 Euro/QALY gained (Norway) for 5-yearly mailing an HPV-SS kit to women non-compliant after the first reminder letter. An ICER of 119,000 Euro/LYG was found in a Swedish study for a combined strategy (cytology screening up to the age 35 years + screening with HPV-SS as of age 35 years). Studies assessing screening participation showed HPV-SS to increase screening participation.

Conclusion: Based on our systematic literature review on cost-effectiveness studies evaluating HPV-SS for cervical cancer screening, screening with HPV-SS can be a cost effective, practical, and feasible approach to increase screening participation rate.

The authors declare that they have no competing interests.

The authors declare that an ethics committee vote is not required.

The contribution has already been published: 36. Deutscher Krebskongress, 21.–24. Februar 2024, Berlin [1]