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. In the UK, around 3,200 new cases are diagnosed each year. It is estimated that 99.8% of these cases are preventable through early detection and management. Since cervical cancer is caused by persistent infection of human papillomavirus (HPV), well-organised HR-HPV screening programmes are key to population-level prevention. The success of any such screening programme depends heavily on participation rates.

In England, women aged 25- 64 are offered regular HPV primary 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 vaginal samples or urine may improve the uptake of screening, but the impact on screening costs was unclear.

Aquarius undertook a cost-consequence analysis using a decision tree model from the perspective of the English NHS to compare the costs incurred by the health system in using three different sample collection methods for HR-HPV screening: 1) attending an appointment with a nurse or doctor to have a cervical sample taken (as is currently used for cervical cancer screening in England), 2) self-collected first-void urine using the Colli-Pee® collection device, and 3) self-collected vaginal samples using the FLOQSwab self-sampling kit. Both self-collection methods assumed self-collection was performed at home, with the sample being sent in the post to the laboratory for HPV testing.

In the base-case analysis, the average cost per complete screen was £56.81 for clinician-collected cervical sampling, £38.57 for FV urine self-sampling and £40.37 for vaginal self-sampling. Scaled to consider routine screening in England, if uptake in non-attenders increased by 15% and 50% of current screeners converted to self-sampling, the NHSCSP would save £19.2 million (FV urine) or £16.5 million (vaginal) per year overall.

This evaluation provides early evidence that self-sampling within HPV primary screening could provide a less costly alternative to clinician-collected sampling if the assumptions in our model are accurate. Given the relative acceptability of self-sampling techniques, this could have a significant impact on screening uptake rates, leading to improved screening coverage and cervical cancer prevention.

The full results of the study are now available for 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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