A recent study has revealed that mailing human papillomavirus (HPV) self-sampling kits to underscreened women within US-based private integrated healthcare systems is cost-effective and may provide an efficient outreach strategy to increase cervical cancer screening rates among eligible women. Cervical cancer is preventable by addressing precancers caused by high-risk HPV, and recent advances have made HPV-only (primary HPV) screening more sensitive than a Papanicolaou test alone for detecting precancerous cervical lesions. The findings were published in JAMA Network Open.
The Home-Based Options to Make Cervical Cancer Screening Easy (HOME) randomised clinical trial was conducted within Kaiser Permanente Washington (KPWA), an integrated private health care system in Washington State. The trial compared a mailed HPV self-sampling intervention with KPWA’s usual care outreach for in-clinic screening. Screening uptake increased among underscreened women receiving mailed HPV kits compared with those receiving usual care, supporting the feasibility of mailing HPV kits to women overdue for screening as an effective outreach strategy.
The primary economic outcome of this study was the incremental cost-effectiveness ratio (ICER) for increased screening uptake. Among 19,851 women, ICERs ranged from $86–$146 per additional completed screening. These findings suggest that mailing HPV self-sampling kits to individuals who are overdue for cervical cancer screening is cost-effective and may be an efficient outreach strategy to increase screening rates among eligible women.
Although the study was conducted within a mixed-model healthcare system in one US region, it generates important US-based cost-effectiveness data. The limitations of the study include that it does not address the lack of studies in low- and middle-income settings or predominantly rural settings. Economic analyses of mailed HPV self-screening in such settings remain important given the growing evidence of self-screening acceptability within communities of immigrants, women living in rural areas, and women with limited access to care.
Additionally, the HOME trial did not collect data on HPV vaccination history, limiting the ability to inform the association of cost-effectiveness with HPV vaccine uptake. However, this limitation is reasonable considering that most participants would have been ineligible for HPV vaccination before their first sexual intercourse.
Despite these limitations, the study offers valuable insights into the cost-effectiveness of mailing HPV self-sampling kits. However, it does not address the affordability of this program for healthcare systems, especially in the US. Future work will involve conducting a budget impact analysis evaluating the overall cost of implementing a HOME-type program within a health care system.
The economic evaluation of mailing HPV self-sampling kits to women overdue for cervical cancer screening indicates that the program is cost-effective compared to usual care in terms of increasing screening uptake at a reasonable cost within a private integrated healthcare system. These results support mailing HPV kits as an efficient outreach strategy for increasing screening rates in US healthcare systems, ultimately helping to prevent cervical cancer and reduce its associated mortality.
