P10-05THE COST-EFFECTIVENESS OF HPV SELF-SAMPLING FOR NON-ATTENDERS IN A DANISH CERVICAL CANCER SCREENING PROGRAM

10. Self-sampling
C. Asjes 1, J. Bonde 2, M.V. Hessner Jochumsen 2, D.M. Ejegod 2, L. Vaughan 1.
1BD (Becton, Dickinson and Company), Franklin Lakes, New Jersey, US (United States), 2Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark (Denmark)

Background / Objectives

Cervical cancer screening programs are responsible for declining rates of cervical cancer mortality around the globe. However, incidence rate of cervical cancer remains high in un-screened women not attending screening. In the Capital Region of Denmark (RegionH), 24% of women remain unscreened, accounting for 50% of cancers in the region. To address this challenge, the Copenhagen Self-Sampling Initiative (CSi) pilot program was initiated to test the effectiveness of HPV self-sampling as a strategy to reach unscreened women. The pilot successfully demonstrated that 30% of unscreened women could be brought into the screening program2.

Based on the results of the CSi pilot, the RegionH is now implementing self-sampling as a general offer to screening non-attenders over a period of 3 years. A health economic model was developed to predict the cost-effectiveness of this initiative.


Methods

An Excel-based budget impact model was constructed and calibrated with data from the published literature for Denmark’s population, HPV prevalence, and outcomes. Costs were calculated based on direct data from the CSi pilot2,3. For ages 30–59 years, the model compared two identical cytology primary screening algorithms, of which one offered self-sampling.  


Results

At full implementation, over 1 screening cycle, the RegionH could expect to bring an additional 32,050 unscreened women into the screening program utilizing self-sampling. Through this additional coverage, 8% more ≥CIN2 and 32% more cancers would be detected. Based on previous analysis in Denmark, it’s expected that 16% of these CIN2 and CIN3 cases, if left untreated, would progress to cancer1.  The total costs of the self-sampling program would be an incremental €21,861. This translates to €14 per woman brought into the regular screening program, €1,728 per ≥CIN2 detected, €21,861 per cancer detected, and €11,733 per cancer avoided.   


Conclusion

As self-sampling is currently being rolled out in the RegionH, it’s important to understand the cost-effectiveness of this strategy. This analysis demonstrates that self-sampling is a cost-effective strategy to increase coverage of cervical cancer screening programs, improving outcomes for patients. 


References

1Barken et al. Int. J. Cancer: 130, 2438–2444 (2012)

2Lam et al, int.J.Cancer : 140,2212-2219 (2017)

3Lam et al, J. Clin.Micro, in press (2017)