A recent randomized clinical trial demonstrated that mailing human papillomavirus (HPV) self-sampling kits to individuals due for cervical cancer screening is more cost-effective than traditional care methods. Traditional care included clinician electronic medical record alerts, mailed patient reminders, educational materials, and opt-in screening approaches.
Study Design and Population
The study analyzed data from 31,355 participants aged 30 to 64 over two years, with an average age of 45.9 years. Participants were categorized into three groups based on their cervical cancer screening history: adherent (41.4%), overdue (26.3%), and screening history unknown (31.6%). The primary outcome measured was the completion of cervical cancer screening within six months after randomization.
Costs per Screening Completed
For individuals overdue for screening, mailing HPV self-sampling kits directly resulted in costs ranging from a savings of $19 (95% CI, -21 to -16) to an additional cost of $63 (95% CI, 39 to 87) per screening completed. This variation depended on specific subgroup characteristics and program expenses.
The overall program costs per member per month for delivering screening were $16.73 for adherent participants, $9.88 for overdue participants, and $8.44 for those with unknown screening histories.
Budget Impact Over Time
Although the adherent subgroup had the highest budget for sending self-sampling kits during the first year—approximately $1 million—this cost decreased significantly over time. By the fourth year, their budget had dropped to about $150,000, representing the lowest cost among the subgroups.
Practical Implications
The research team, led by Richard Meenan, PhD, MPH, MBA, at Kaiser Permanente Northwest, concluded that directly mailing HPV kits to eligible individuals is a practical, efficient, and affordable outreach strategy to increase cervical cancer screening rates.
Study Limitations
This trial was limited to one US health system where all participants had health insurance and access to primary care clinicians. Additionally, the study period coincided with the COVID-19 pandemic, during which in-person medical visits were restricted, possibly affecting generalizability.
Funding and Disclosures
Several authors disclosed receiving grants from public health agencies, including the National Cancer Institute, National Heart, Lung, and Blood Institute, the CDC, and the Patient-Centered Outcomes Research Institute, unrelated to this submitted work.
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