Health-Economic Evaluation of Screening Strategies Including HPV Self-Sampling Offered to Non-Attendees of the Organized Cervical Cancer Screening Program in Germany

Introduction In Germany, about 30% of eligible women for cervical cancer (CC) screening do not regularly participate in the national organized program. Offering self-sampling for human papillomavirus (HPV) screening alongside the current program could be beneficial and cost-effective. We assessed the long-term health impact and cost-effectiveness of offering HPV self-sampling (HPV-SS) as an additional option for non-participants.

Methods A validated Markov state-transition model for the German context was used to evaluate eight different screening HPV-SS strategies compared to standard clinician-based screening (annual cytology for women age 20-34 years; triennial co-testing with HPV and cytology thereafter) including HPV-SS for non-participants in the age ranges 25-65, 30-65 or 35-65 years, every five years with regular invitation, either opt-in (invitation with link to order the test) or send-to-all (test sent with invitation). German clinical, epidemiological, economic data (index year 2023), as well as test accuracy and HPV-SS-participation data from international meta-analyses and trials were included. Reported outcomes include undiscounted life-years gained (LYG) per 100,000 women compared to standard screening without HPV-SS in non-participants, and the incremental cost-effectiveness ratio (ICER; in EUR/LYG). Comprehensive sensitivity analyses were performed to assess the robustness of findings.

Results Incremental undiscounted effectiveness per 100,000 women (compared to standard screening without HPV-SS) and discounted ICERs (compared to next effective) for non-dominated HPV-SS screening strategies were 89.6 LYG (22,700 EUR/LYG) for offering with five-yearly screening invitation an HPV-SS (opt-in) to non-participants age 35-65, 165.9 LYG (25,900 EUR/LYG) for HPV-SS (send-to-all) age 35-65, 166.8 (726,000 EUR/LYG) for HPV-SS (send-to-all) age 30-65, and 167.2 LYG (1,78 Mio. EUR/LYG for HPV-SS (send-to-all) age 25-65 years. Other opt-in strategies were dominated. Results were robust over a wide range of parameter variations.

Conclusion Offering HPV-SS every five years as of age 35 (send-to-all) to women not participating in the German national screening program as an additional strategy is effective and cost-effective in the German healthcare context. Future research should include additional strategies with different age limits, intervals or target populations for HPV-SS to assess the health-economic impact. Results may inform decision making on HPV self-sampling integration into the established organized cervical cancer screening program in Germany.

Publication History

Article published online:
05 December 2024