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Haguenoer K, Sengchanh S, Gaudy-Graffin C, Boyard J, Fontenay R, Marret H, Goudeau A, Pigneaux de Laroche N, Rusch E, Giraudeau B. Vaginal self-sampling is a cost-effective way to increase participation in a cervical cancer screening programme: a randomised trial. Br J Cancer 2014; 111:2187-96. [PMID: 25247320 PMCID: PMC4260034 DOI: 10.1038/bjc.2014.510] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/08/2014] [Accepted: 08/20/2014] [Indexed: 01/05/2023] Open
Abstract
Background: Cervical cancer screening coverage remains insufficient in most countries. Our objective was to assess whether in-home vaginal self-sampling with a dry swab for high-risk human papillomavirus (HR-HPV) testing is effective and cost-effective in increasing participation in cervical cancer screening. Methods: In March 2012, 6000 unscreened women aged 30–65 years, living in a French region covered by a screening programme, who had not responded to an initial invitation to have a Pap smear were equally randomised to three groups: ‘no intervention' ‘recall', women received a letter to have a Pap smear; and ‘self-sampling', women received a self-sampling kit to return to a centralised virology laboratory for PCR-based HPV testing. Results: Participation was higher in the ‘self-sampling' than in the ‘no intervention' group (22.5% vs 9.9%, P<0.0001; OR 2.64) and ‘recall' group (11.7%, P<0.0001; OR 2.20). In the ‘self-sampling' group, 320 used the self-sampling kit; for 44 of these women with positive HR-HPV test results, 40 had the recommended triage Pap smear. The ICER per extra screened woman was 77.8€ and 63.2€ for the ‘recall' and ‘self-sampling' groups, respectively, relative to the ‘no intervention' group. Conclusions: Offering an in-home, return-mail kit for vaginal self-sampling with a dry swab is more effective and cost-effective than a recall letter in increasing participation in cervical cancer screening.
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Affiliation(s)
- K Haguenoer
- 1] INSERM, U1153, Paris, France [2] Cancer Screening Department, CHRU de Tours, Tours 37000, France
| | - S Sengchanh
- Cancer Screening Department, CHRU de Tours, Tours 37000, France
| | - C Gaudy-Graffin
- 1] Department of Bacteriology and Virology, CHRU de Tours, Tours 37000, France [2] Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours 37000, France [3] INSERM U966, Tours 37000, France
| | - J Boyard
- Cancer Screening Department, CHRU de Tours, Tours 37000, France
| | - R Fontenay
- Medico-Economic Evaluation Unit, CHRU de Tours, Tours 37000, France
| | - H Marret
- 1] Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours 37000, France [2] Department of Gynaecology and Obstetrics, CHRU de Tours, Tours 37000, France
| | - A Goudeau
- 1] Department of Bacteriology and Virology, CHRU de Tours, Tours 37000, France [2] Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours 37000, France [3] INSERM U966, Tours 37000, France
| | | | - E Rusch
- 1] Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours 37000, France [2] Medico-Economic Evaluation Unit, CHRU de Tours, Tours 37000, France [3] Université François-Rabelais, Équipe émergente de recherche Éducation, Éthique, Santé, Tours, France
| | - B Giraudeau
- 1] INSERM, U1153, Paris, France [2] Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours 37000, France [3] CHRU de Tours, INSERM CIC1415, Tours 37000, France
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