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Mailing human papillomavirus self-sampling kits to eligible women is a cost-effective method to improve screening rates for cervical cancer in the US healthcare system.

Cervical cancer is largely preventable through early screening for precancerous changes caused by human papillomavirus (HPV). The currently available method for HPV-only (primary HPV screening) is more sensitive than the standard Papanicolaou (Pap) cytology-based testing. Home-based HPV-only sampling kits have an additional advantage over Pap testing as they allow for sample collection by individuals themselves.

Worldwide clinical trials have established that mailing HPV sampling kits results in higher screening rates among under-screened women. Similar results were concluded by the Home-Based Options to Make Cervical Cancer Screening Easy (HOME) clinical trial, conducted in Kaiser Permanente Washington (KPWA), a private healthcare system in Washington State. In order to establish the self-sampling program successfully, it is necessary to evaluate its cost-effectiveness in specific settings. Organized national screening programs have established it as a cost-effective method in European settings. Multiple less-organized healthcare systems are now adopting this screening method in the US. Thus, there is a need for evaluation of costs in such systems, as well. Recently this was achieved by a study published in JAMA Network Open.

Study Population

Results from the HOME trial were used for cost-effectiveness analysis. The study comprised 19,851 eligible participants aged 30 to 64 years, all of whom were registered in a health plan for at least three years and five months. A total of 9960 subjects were randomized to the intervention group, while 9891 were placed in the control group. The control group received usual screening reminders and outreach, whereas the intervention group additionally received a mailed HPV self-sampling kit.

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HOME Trial Results

The study found greater utilization of screening by the intervention group (26.3%) compared to the control group (17.4%).

Cost-Effectiveness Results

The self-sampling intervention achieved additional cervical cancer screenings at an incremental cost ranging from $85.84 to $146.29, depending on the cost basis utilized (KPWA sampling kit or Medicare-based Pap test). Compared to other sub-groups, most cost-effectiveness at lower willingness-to-pay levels was accomplished in participants aged 50–64 years and in subjects whose last Pap test was >3.4 to <5 years before the trial.

These findings demonstrate that mailing self-sampling HPV kits is a cost-effective strategy for increasing screening rates among eligible women in US health systems.


Meenan, R. T., Troja, C., Buist, D. S. M., Tiro, J. A., Lin, J., Anderson, M. L., Gao, H., Green, B. B., & Winer, R. L. (2023). Economic Evaluation of Mailed Home-Based Human Papillomavirus Self-sampling Kits for Cervical Cancer Screening. JAMA Network Open, 6(3), e234052. https://doi.org/10.1001/jamanetworkopen.2023.4052