Cost-effectiveness of human papillomavirus (HPV) self-collection intervention on cervical cancer screening uptake among underscreened US persons with a cervix

Background: We evaluate the cost-effectiveness of HPV self-collection (followed by scheduling assistance for those who were HPV+ or inconclusive) compared to scheduling assistance only and usual care among underscreened persons with a cervix (PWAC). Methods: A decision tree analysis was used to estimate the incremental cost-effectiveness ratios (ICERs), or the cost per additional PWAC screened, from the Medicaid/state and clinic perspectives. A hypothetical cohort represented 90,807 low-income, underscreened individuals. Costs and health outcomes were derived from the MyBodyMyTest-3 randomized trial except the usual care health outcomes were derived from literature. We performed probabilistic sensitivity analyses (PSA) to evaluate model uncertainty. Results: Screening uptake was highest in the self-collection alternative (n=65,721), followed by the scheduling assistance alternative (n=34,003) and usual care (n=18,161). The self-collection alternative cost less and was more effective than the scheduling assistance alternative from the Medicaid/state perspective. Comparing the self-collection alternative to usual care, the ICERs were $284 per additional PWAC screened from the Medicaid/state perspective and $298 per additional PWAC screened from the clinic perspective. PSAs demonstrated that the self-collection alternative was cost-effective compared to usual care at a willingness-to-pay threshold of $300 per additional PWAC screened in 66% of simulations from the Medicaid/state perspective and 58% of simulations from the clinic perspective. Conclusion: Compared to usual care and scheduling assistance, mailing HPV self-collection kits to underscreened individuals appears to be cost-effective in increasing screening uptake. Impact: This is the first analysis to demonstrate the cost-effectiveness of mailed self-collection in the US.