Mailing HPV kits effective for increasing cervical cancer screening uptake

Key takeaways :

• Mailed HPV self-sampling kits increased completed screenings at cost-effectiveness ratios ranging from $85.84 to $146.29.
• Findings support mailing HPV kits as an efficient strategy increasing screening.

Mailing HPV self-sampling kits to women who are overdue for cervical cancer screening was cost-effective in increasing screening uptake compared with usual care, according to an economic evaluation published in JAMA Network Open.

“Home-based HPV-only screening is feasible because, unlike Papanicolaou tests, both clinicians and individuals can collect vaginal HPV samples. Vaginal samples are accurate for detecting CIN2+ and use the same HPV assay as cervical HPV samples,” Richard T. Meenan, PhD, MPH, MBA, of the Center for Health Research at Kaiser Permanente Northwest, Portland, and colleagues wrote. “Home-based screening reduces the need for office visits and addresses well-documented barriers to regular screening, including Papanicolaou-related discomfort for embarrassment and difficulty scheduling or attending medical appointments.”

In this economic evaluation, researchers conducted a cost-effective analysis of results derived from a randomized clinical trial of 19,851 women (mean age, 50.1 years) aged 30 to 64 years from February 2014 to August 2016. All women were enrolled in a health plan from Kaiser Permanente Washington for at least 3 years and 5 months, had a primary care clinician, had not received a Pap test for at least 3 years and 5 months, and had not had a hysterectomy.

In the randomized clinical trial, 9,960 women were randomly assigned to the intervention group, which involved usual care plus a mailed HPV self-sampling kit, and 9,891 women were randomly assigned to usual care, which involved patient reminders and an ad hoc outreach for screening. The primary outcome was the incremental cost-effectiveness ratio for increased screening uptake within 6 months of randomization.

Women in the intervention group had higher screening uptake compared with women in the control group (26.3% vs. 17.4%; RR = 1.51; 95% CI, 1.43-1.6). Baseline incremental cost-effectiveness ratios ranged from $85.84 per additional completed screening when using Kaiser Permanente Washington wellness visits as the cost source to $146.29 when using Medicare Pap test-only visits as the cost source.

A subgroup of women aged 50 to 64 years and women who were most recently overdue for screening experienced cost-effectiveness at lower levels of willingness to pay for additional completed screening compared with other subgroups.

“These results support mailing HPV kits as an efficient outreach strategy for increasing screening rates in U.S. health care systems,” the researchers wrote.