Under which realistic circumstances is hrHPV self-sampling increasing cervical screening effectiveness in a partly vaccinated population?: A modelling study
High-risk Human Papillomavirus self-sampling can increase attendance rates for screening. However, observed lower sensitivity and loss to follow-up of self-sampling could reduce programme effectiveness when attenders of clinician-collected sampling switch to self-sampling. We determined the tipping...
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| Main Authors: | , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
1 March 2026
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| In: |
International journal of cancer
Year: 2026, Volume: 158, Issue: 5, Pages: 1361-1369 |
| ISSN: | 1097-0215 |
| DOI: | 10.1002/ijc.70184 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.1002/ijc.70184 Verlag, kostenfrei, Volltext: https://onlinelibrary.wiley.com/doi/abs/10.1002/ijc.70184 
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| Author Notes: | Sylvia Kaljouw, Erik E.L. Jansen, Ellen M.G. Olthof, Jan A.C. Hontelez, Inge M.C.M. de Kok |
| Summary: | High-risk Human Papillomavirus self-sampling can increase attendance rates for screening. However, observed lower sensitivity and loss to follow-up of self-sampling could reduce programme effectiveness when attenders of clinician-collected sampling switch to self-sampling. We determined the tipping point for effectiveness (based on life years gained [LYG]) of self-sampling and the consequences for cost-effectiveness, taking into account waste by comparing full opt-out (no waste) to no opt-out (waste from unused self-sampling kits). We used the STDSIM-MISCAN-Cervix microsimulation model to simulate a population of Dutch women born in 2000 (50% vaccinated [sensitivity analysis: 0-100%], 70% screening attendance [sensitivity analysis: 60-80%]). Self-sampling deployment strategies (e.g., direct-mail) were varied by the percentage of original attenders switching to self-sampling and the percentage of new attendance from non-attenders. Main outcome measures were LYG and cost-effectiveness (cost per quality adjusted [QA] LY gained) compared to the current programme. We found that if self-sampling does not reach non-attenders, life years cannot be gained. When reaching 10% or 30% of non-attenders, the tipping point lies at ≤40% and ≤100% switchers to maintain effectiveness, respectively (+4 LYG, +10 LYG). Scenarios were cost-effective (<€50,000/QALY gained) if at least 10% of non-attenders were reached. Full opt-out improved cost-effectiveness substantially. So, in a partly vaccinated population, self-sampling deployment strategies need to reach at least 10% of non-attenders to maintain programme effectiveness and cost-effectiveness. A well-functioning opt-out system further improves cost-effectiveness by preventing waste. |
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| Item Description: | Erstveröffentlichung: 9. Oktober 2025 Gesehen am 02.03.2026 |
| Physical Description: | Online Resource |
| ISSN: | 1097-0215 |
| DOI: | 10.1002/ijc.70184 |