Sammendrag
Several countries have implemented primary human papillomavirus (HPV) testing for
cervical cancer screening. HPV testing enables home-based, self-collected sampling
(self-sampling), which provides similar diagnostic accuracy as clinician-collected samples. We evaluated the impact and cost-effectiveness of switching an entire organized screening program to primary HPV self-sampling among cohorts of HPV
vaccinated and unvaccinated Norwegian women. We conducted a model-based
analysis to project long-term health and economic outcomes for birth cohorts with
different HPV vaccine exposure, that is, preadolescent vaccination (2000- and
2008-cohorts), multiage cohort vaccination (1991-cohort) or no vaccination (1985-
cohort). We compared the cost-effectiveness of switching current guidelines with
clinician-collected HPV testing to HPV self-sampling for these cohorts and considered
an additional 44 strategies involving either HPV self-sampling or clinician-collected
HPV testing at different screening frequencies for the 2000- and 2008-cohorts. Given
Norwegian benchmarks for cost-effectiveness, we considered a strategy with an additional cost per quality-adjusted life-year below $55 000 as cost-effective. HPV selfsampling strategies considerably reduced screening costs (ie, by 24%-40% across
cohorts and alternative strategies) and were more cost-effective than cliniciancollected HPV testing. For cohorts offered preadolescent vaccination, cost-effective
strategies involved HPV self-sampling three times (2000-cohort) and twice
(2008-cohort) per lifetime. In conclusion, we found that switching from cliniciancollected to self-collected HPV testing in cervical screening may be cost-effective
among both highly vaccinated and unvaccinated cohorts of Norwegian women.
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