Home-based HPV screening appears cost-effective, study finds

In an economic evaluation of 19,851 female participants from a randomized clinical trial, incremental cost-effectiveness ratios for increased uptake of human papillomavirus (HPV) screening ranged from $86 to $146 per additional screening completed.

Mailing human papillomavirus (HPV) self-sampling kits to women who are overdue for cervical cancer screening is cost-effective and may be an efficient outreach strategy to increase screening rates, a study found.

Researchers conducted an economic evaluation of a mailed HPV self-sampling intervention among underscreened women enrolled in an integrated U.S. health care system. Women were identified through electronic medical records. Eligible participants had been enrolled in a health plan for at least three years and five months, had a primary care clinician, had not received a Pap smear for at least three years and five months, and had not undergone a hysterectomy.

Patients in the control group received usual care, defined as reminders and ad hoc outreach for screening, while patients in the intervention group received usual care plus a mailed HPV self-sampling kit. The primary economic outcome was the incremental cost-effectiveness ratio (ICER) for increased screening uptake, defined as the incremental difference in cost (intervention group minus control group) divided by the difference in the number of participants completing screening (intervention group minus control group) within six months of randomization. Results were published March 22 by JAMA Network Open.

A total of 9,960 women were randomized to the intervention group and 9,891 were randomized to the control group. The mean age was 50.1 years, 9.7% were Asian, 4.7% were Black or African American, and 76.7% were White. Screening uptake was higher in the intervention group than in the control group (26.3% vs. 17.4%; relative risk, 1.51 [95% CI, 1.43 to 1.60]). Overall, 1,440 participants in the intervention group received a Pap test directly in the clinic, and 1,206 participants returned mailed HPV kits, with 1,178 of these meeting the criteria for completing screening. Twelve participants in the intervention group versus eight participants in the control group had positive results for CIN2+ (relative risk, 1.49; 95% CI, 0.61 to 3.64); all 12 intervention participants and seven control participants were treated (relative risk, 1.70; 95% CI, 0.67 to 4.32). The ICER at baseline ranged from $85.84 (95% CI, $85.68 to $85.99) per additional completed screening using the health system's wellness visits as the cost basis to $146.29 (95% CI, $146.20 to $146.38) using Medicare Pap test-only visits as the cost basis.

The study was conducted in only one region, did not collect data on HPV vaccination history, and involved patients who all had health insurance and a primary care physician, among other limitations, the researchers noted. “In this economic evaluation of a program of mailing HPV self-sampling kits to women who were overdue for cervical cancer screening, the program was cost-effective relative to usual care in terms of increasing screening uptake at a reasonable cost within a private integrated health care system,” they wrote. “These results support mailing HPV kits as an efficient outreach strategy for increasing screening rates in US health care systems.”