Cost Measurement
CERVICAL CANCER
Intervention costs were defined as the value of resources used to implement the mailed HPV kit program during the HOME trial and were measured from the health care system perspective. A microcost analysis was used to assess intervention resources, and resources were classified as labor or nonlabor. Intervention cost data came from expense reports, the KPWA cost management database, and external sources (eg, the 2021 Medicare Physician Fee ScheduleWe also focused on eligible women who were overdue for routine cervical cancer screening; therefore, once screened, a participant was removed from the screening pool. Although abnormal screening results would induce subsequent follow-up costs (eg, a mild abnormal case in 1 year would require a repeat cotesting in 12 months), we excluded these costs. We focused on the cost-effectiveness of the HOME intervention in increasing the rate of completed screening uptake. In addition, the low (12.0%) proportion of abnormal cases requiring surveillance in the sample (1.5% of those who received usual care, 5.2% of those who received a mailing and a direct in-clinic Papanicolaou test, and 4.2% of those who received a mailing and a self-sampling HPV test) implied that follow-up costs would not materially change the results given the sample size. Costs were not discounted because of the 18-month study period but were adjusted to 2021 values using the medical care Consumer Price Index for urban consumers.