Discussion
cancer
CANCER, CERVICAL CANCER
In this economic evaluation of results from a randomized clinical trial conducted within a US-based integrated health care system, our mailed HPV self-sampling intervention generated additional completed cervical cancer screenings at an incremental cost from $85.84 to $146.29, depending on the cost basis used (KPWA or Medicare). The intervention achieved cost-effectiveness at lower system WTP levels among subgroups of women aged 50 to 64 years and those whose last Papanicolaou test was more than 3.4 years to less than 5.0 years before randomization than other subgroups.Although our analysis incorporated clinic visit costs associated with Papanicolaou procedures, triage strategies are currently being studied that may incorporate testing positive self-samples with additional molecular markers to avoid a clinic visit.A previous HPV self-collection systematic reviewOur study focused on assessing the cost-effectiveness of the HOME trial intervention in increasing the proportion of eligible women receiving appropriate cervical cancer screening within a US-based private health care system. Eligible studies included in the previous systematic reviewOur results regarding the cost-effectiveness of an HPV self-sampling intervention were also consistent with those obtained in similar studies conducted in other settings and studiesOur analysis benefitted from the randomized clinical trial design and a large sample size that allowed us to evaluate the cost-effectiveness of the HOME intervention and to conduct relevant subgroup analyses (ie, age and screening history). Including KPWA and Medicare cost bases allowed comparability between representative US-based private and public payers. We also included the underlying clinic visit cost associated with a Papanicolaou procedure. Although not strictly part of the mailed HPV test intervention, the visit was an important resource associated with any Papanicolaou procedure performed within the trial.The HOME study was conducted before the beginning of the COVID-19 pandemic in March 2020. It is well established that cancer screening rates internationally, including cervical cancer screening rates, decreased substantially during the pandemic.