Under which realistic circumstances is hrHPV self-sampling increasing cervical screening effectiveness in a partly vaccinated population - A modelling study

Q: What is the main goal of the modelling study?

To determine when hrHPV self-sampling increases cervical screening effectiveness and remains cost-effective in a partly vaccinated population, especially under switching from clinician-collected sampling to self-sampling.

Q: What outcomes were used to judge effectiveness and value?

Effectiveness was measured using life years gained (LYG), and cost-effectiveness was evaluated as cost per quality-adjusted (QA) life year gained.

Q: When can self-sampling maintain programme effectiveness?

The model indicates no life years are gained unless self-sampling reaches non-attenders; when 10% or 30% of non-attenders are reached, the allowable switchers to self-sampling are up to 40% or 100%, respectively.

Sep 29, 2026

Uploaded by James

High-risk Human Papillomavirus self-sampling can increase attendance for cervical screening, yet reduced sensitivity and loss to follow-up may offset benefits when those who would otherwise attend switch to self-sampling. The study identified the effectiveness tipping point, measured in life years gained (LYG), and assessed cost-effectiveness, incorporating waste from self-sampling kits through opt-out versus no opt-out scenarios. Using STDSIMISCAN-Cervix for a Dutch population born in 2000, results show effectiveness requires reaching non-attenders and cost-effectiveness requires at least 10% reach.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Abstract

Effectiveness tipping point and cost-effectiveness outcomes

Model and scenario design (STDSIMISCAN-Cervix)

Introduction

Dutch national primary hrHPV screening programme

Rationale and problem of self-sampling uptake

DOI: 10.1002/ijc.70184 RES EARCH A RTICLE Cancer Therapy a nd Prevention Under which realistic circumstances is hrHPV self-sampling increasing cervical screening effectiveness in a partly vaccinated population? A modelling study Sylvia Kaljouw 1 | Erik E. L. Jansen 1 | Ellen M. G. Olthof 1 | Jan A. C. Hontelez 1,2 | Inge M. C. M. de Kok 1 1Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands 2Heidelberg Institute of Global Health, Universitätsklinikum Heidelberg, Heidelberg, Germany Correspondence Inge M. C. M. de Kok, Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Office Na2401, Dr. Molewaterplein 40, 3015GD Rotterdam. Email: [i.dekok@erasmusmc.nl](i.dekok@erasmusmc.nl) Funding information Dutch National Institute for Public Health and the Environment Abstract High-risk Human Papillomavirus self-sampling can increase attendance rates for screening. However, observed lower sensitivity and loss to follow-up of self-sampling could reduce programme effectiveness when attenders of clinician-collected sampling switch to self-sampling. We determined the tipping point for effectiveness (based on life years gained [LYG]) of self-sampling and the consequences for costeffectiveness, taking into account waste by comparing full opt-out (no waste) to no opt-out (waste from unused self-sampling kits) . We used the STDSIMMISCAN-Cervix microsimulation model to simulate a population of Dutch women born in 2000 (50% vaccinated [sensitivity analysis: 0–100%], 70% screening attendance [sensitivity analysis: 60–80%]) . Self-sampling deployment strategies (e.g., direct-mail) were varied by the percentage of original attenders switching to self-sampling and the percentage of new attendance from non-attenders. Main outcome measures were LYG and cost-effectiveness (cost per quality adjusted [QA] LY gained) compared to the current programme. We found that if self-sampling does not reach non-attenders, life years cannot be gained. When reaching 10% or 30% of non-attenders, the tipping point lies at ≤40% and ≤100% switchers to maintain effectiveness, respectively (+4 LYG, +10 LYG) . Scenarios were cost-effective (<€50,000/ QALY gained) if at least 10% of non-attenders were reached. Full opt-out improved cost-effectiveness substantially. So, in a partly vaccinated population, self-sampling deployment strategies need to reach at least 10% of non-attenders to maintain programme effectiveness and cost-effectiveness. A well-functioning opt-out system further improves cost-effectiveness by preventing waste. KEYWOR DS cost-effectiveness, hrHPV, self-sampling, vaccination Abbreviations: ASC-US, atypical squamous cells of undetermined significance; CIN, cervical intraepithelial neoplasia; FIGO, International Federation of Gynecology and Obstetrics; hrHPV, high-risk Human Papillomavirus; LTFU, loss to follow-up; LYG, life years gained; MISCAN, microsimulation screening analysis; QALY, quality adjusted life year; STDSIM, sexually transmitted disease simulation. We have presented preliminary results of this study at a conference (SMDM Annual North American Meeting 2022) . This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. © 2025 The Author(s) . International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC. What's New? Offering the option of self-sampling in cervical cancer screening programs could increase participation. However, it could also prompt participants to switch from clinician-collecting sampling, which has demonstrated higher testing sensitivity and lower loss to follow-up. By modelling 30 self-sampling scenarios in a partly vaccinated population, here the authors estimated that when 10% of non-particip

FAQs

What is the main goal of the modelling study?

To determine when hrHPV self-sampling increases cervical screening effectiveness and remains cost-effective in a partly vaccinated population, especially under switching from clinician-collected sampling to self-sampling.

What outcomes were used to judge effectiveness and value?

Effectiveness was measured using life years gained (LYG), and cost-effectiveness was evaluated as cost per quality-adjusted (QA) life year gained.

When can self-sampling maintain programme effectiveness?

The model indicates no life years are gained unless self-sampling reaches non-attenders; when 10% or 30% of non-attenders are reached, the allowable switchers to self-sampling are up to 40% or 100%, respectively.

Sep 29, 2026

Uploaded by James