The cost-effectiveness of cervical self-sampling to improve routine cervical cancer screening : The importance of respondent screening history and compliance
Menée à partir de données norvégiennes et à l'aide d'une simulation de deux scénarios prenant en compte le niveau de participation au programme de dépistage du cancer du col de l'utérus, cette étude compare les rapports coût-efficacité de deux stratégies pour améliorer le taux de participation : l'une consistant à envoyer des lettres de rappel, l'autre à envoyer des kits d'auto-prélèvement d'échantillons cervico-vaginaux
Background : 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.
Methods : We compared a strategy reflecting screening participation (using reminder letters) to strategies that involved mailing self-sampling device kits to women non-compliant to screening within a 5-year 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.
Results : Mailing self-sampling device kits to all women non-compliant to screening within a 5-year 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.
Conclusions : Targeted self-sampling of non-compliers likely represents good value-for-money; however, the preferred strategy is contingent on the screening histories and compliance of respondents. Impact: 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 Epidemiology Biomarkers & Prevention , résumé, 2016