Aquarius Population Health

Our recently published paper comparing different cervical screening options in England provides early economic evidence that sample self-collection may be a cost-effective option for cervical cancer screening programmes. This work supports decision-making for cervical screening programmes.

Cervical cancer is the fourth most common cancer among women worldwide, yet most cases are preventable through early detection and management which is why screening for cervical cancer is so important. In England, women aged 25- 64 are offered regular cervical screening which requires them to attend an appointment and have a cervical sample collected by a nurse or doctor. For reasons such as embarrassment, fear, and inconvenience, less than 75% of women eligible for screening choose to participate. Offering additional choices such as self-collection of samples such as urine may help in improving the uptake of screening.

In the past, women were screened by examining cells from the cervix to find cellular abnormalities that indicate a pre-cancer stage. In England and many other countries, an HPV primary approach is now used. Samples are first tested for the presence of human papillomavirus (HPV) genotypes associated with cervical cancer. If the test is positive, then a sample is collected to look for cellular abnormalities. This change to HPV primary screening reduces unnecessary investigations and means that other types of samples (non-cellular), such as urine or vaginal swabs could be used for the first step of the screening protocol. Women can take their own sample at home and then send it in the post to the laboratory for HPV testing. Self-collection is already used for other types of screening such as chlamydia and colorectal cancer. In recent years there has been a growing interest in self-collection of samples for cervical cancer screening, and it has been introduced as an option in a handful of countries including Sweden and The Netherlands in the hope that it increases access to testing and screening uptake. 

We were interested to explore the cost of using different self-collection methods and how this might impact the screening programme in England. Novosanis (Wijnegem, Belgium) commissioned Aquarius to develop this economic evidence. In collaboration with screening experts from the University of Manchester, we developed a health economic model comparing three ways of collecting samples for cervical cancer screening, quantifying the cost of each method from the healthcare perspective.

The three sample collection methods considered were: 1) clinician-collected cervical samples (as is currently used for cervical cancer screening in England), 2) self-collected first-void urine using the Orasure Colli-Pee® collection device, and 3) self-collected vaginal samples.

In the main analysis, the average cost per completed screen was calculated to be £56.81 for clinician-collected sampling, £38.57 for first-void urine, and £40.37 for vaginal swab. Since it is not clear how many women would choose to self-sample and to what extent screening uptake would change, we assessed several scenarios. Scaled up to consider the total annual screening costs in England, if uptake in non-attenders increased by 15% and half of regular screeners converted to self-sampling, we would anticipate annual savings of up to £19.2 million.

The full results of the study are now available open access on the BMJ Open website.

Huntington S, Puri Sudhir K, Schneider V, et al. Economic evaluation of two self-sampling strategies for HPV primary cervical cancer screening compared with clinician-collected sampling. BMJ Open 2023;0:e068940. doi:10.1136/bmjopen-2022-068940.

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