The cost-effectiveness of opt-in and send-to-all HPV self-sampling among long-term non-attenders to cervical cancer screening in Norway: The Equalscreen randomized controlled trial

Tara Knauss; Bo T Hansen; Kine Pedersen; Gunvor Aasbø; Natalia Kunst; Emily A Burger

doi:10.1016/j.ygyno.2022.10.027

The cost-effectiveness of opt-in and send-to-all HPV self-sampling among long-term non-attenders to cervical cancer screening in Norway: The Equalscreen randomized controlled trial

Gynecol Oncol. 2023 Jan:168:39-47. doi: 10.1016/j.ygyno.2022.10.027. Epub 2022 Nov 11.

Authors

Tara Knauss¹, Bo T Hansen², Kine Pedersen¹, Gunvor Aasbø³, Natalia Kunst⁴, Emily A Burger⁵

Affiliations

¹ Department of Health Management and Health Economics, University of Oslo, Postboks 1089 Blindern, 0317 Oslo, Norway.
² Department of Research, Cancer Registry of Norway, P.O. box 5313 Majorstuen, NO-0304 Oslo, Norway; Department of Infection Control and Vaccine, Norwegian Institute of Public Health, PO Box 222 Skøyen, 0213 Oslo, Norway.
³ Department of Research, Cancer Registry of Norway, P.O. box 5313 Majorstuen, NO-0304 Oslo, Norway; Department of Interdisciplinary Health Science, Institute of Health and Society, University of Oslo, Postboks 1089 Blindern, 0317 Oslo, Norway.
⁴ Department of Health Management and Health Economics, University of Oslo, Postboks 1089 Blindern, 0317 Oslo, Norway; Public Health Modeling Unit, Yale University School of Public Health, P.O. Box 208034, 60 College Street, New Haven, CT 06520-0834, USA; Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale University School of Medicine, Harkness Office Building, 367 Cedar Street, New Haven, CT 06520-8023, USA.
⁵ Department of Health Management and Health Economics, University of Oslo, Postboks 1089 Blindern, 0317 Oslo, Norway; Harvard Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave, Boston, MA, USA. Electronic address: emily.burger@medisin.uio.no.

PMID: 36371904
DOI: 10.1016/j.ygyno.2022.10.027

Abstract

Objective: We assessed the cost-effectiveness of mailing a human papillomavirus self-sampling (HPV-ss) kit, directly or via invitation to order, compared with mailing reminder letters among long-term non-attenders in Norway.

Methods: We conducted a secondary analysis using the Equalscreen study data with 6000 women aged 35-69 years who had not screened in 10+ years. Participants were equally randomized into three arms: reminder letter (control); invitation to order HPV-ss kit (opt-in); directly mailed HPV-ss kit (send-to-all). Cost-effectiveness (2020 Great British Pounds (GBP)) was estimated using incremental cost-effectiveness ratios (ICERs) per additional screened woman, and per additional cervical intraepithelial neoplasia grade 2 or worse (CIN2+) from extended and direct healthcare perspectives.

Results: Participation, CIN2+ detection, and total screening costs were highest in the send-to-all arm, followed by the opt-in and control arms. Non-histological physician appointments contributed to 67% of the total costs in the control arm and ≤ 31% in the self-sampling arms. From an expanded healthcare perspective, the ICERs were 135 GBP and 169 GBP per additional screened woman, and 2864 GBP and 4165 GBP per additional CIN2+ detected for the opt-in and send-to-all, respectively.

Conclusions: Opt-in and send-to-all self-sampling were more effective and, depending on willingness-to-pay, may be considered cost-effective alternatives to improve screening attendance in Norway.

Keywords: Cervical cancer; Cost-effectiveness; Human papillomavirus; Self-sampling.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Cost-Benefit Analysis
Early Detection of Cancer
Female
Human Papillomavirus Viruses
Humans
Mass Screening
Papillomaviridae
Papillomavirus Infections*
Uterine Cervical Dysplasia*
Uterine Cervical Neoplasms* / pathology
Vaginal Smears