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1122 Health-economic evaluation of different screening strategies including HPV self-sampling offered to non-attendees of the organized cervical cancer screening program in Germany
  1. Gaby Sroczynski1,
  2. Lára Run Hallsson1,
  3. Milena Muehler1,
  4. Peter Hillemanns2,
  5. Matthias Jentschke2 and
  6. Uwe Siebert1,3,4
  1. 1Department of Public Health, Health Services Research, and Health Technology Assessment, UMIT TIROL – University for Health Sciences and Technology, Hall In Tirol, Austria
  2. 2Dept. of Ob Gyn, Hannover Medical School, Hannover, Germany
  3. 3Center for Health Decision Science, Departments of Epidemiology and Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, USA
  4. 4Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA


Introduction/Background About 30% of women eligible for cervical cancer (CC) screening remain un/under screened in Germany. In Germany, the organised CC screening includes annual Papanicolaou (Pap) cytology for women age 20–34 years and 3-yearly co-testing with human papillomavirus (HPV) and Pap for women age 35 years or older. We systematically evaluated benefits, risks, and cost-effectiveness of offering additionally HPV self-sampling (HPV-SS) to non-attendees.

Methodology A validated Markov model for the German context was used to evaluate additional HPV-SS for non-attendees age 25–65, 30–65 or 35–65 years, every five years with regular invitation, either Opt-in (invitation with link to order test), or Send-to-all (test sent with invitation) compared to standard CC screening alone. German clinical, epidemiological, economic data (indexed 2022/23), along with test accuracy and HPV-SS-attendance data from international meta-analyses and trials were incorporated. Outcomes included undiscounted life-years gained (LYG) per 1000 women compared to standard screening without HPV-SS in non-attendees, and the incremental cost-effectiveness ratio (ICER; in EUR/LYG). Comprehensive sensitivity analyses were conducted to check the robustness of findings.

Results Incremental undiscounted effectiveness per 1000 women (compared to standard screening without HPV-SS) and discounted ICERs (compared to next effective) for non-dominated HPV-SS screening strategies were 0.90 LYG (22,700 EUR/LYG) for offering with five-yearly screening invitation an HPV-SS (Opt-in) to non-attendees age 35–65, 1.659 LYG (25,900 EUR/LYG) for HPV-SS (send-to-all) age 35–65, 1.668 (726,000 EUR/LYG) for HPV-SS (send-to-all) age 30–65, and 1.672 LYG (1,78 mio. EUR/LYG for HPV-SS (send-to-all) age 25–65 years. Other Opt-in strategies were dominated. Results were robust over a wide range of parameter variations.

Conclusion Offering HPV-SS (Send-to-all) to non-attendees every five years as of age 35 as an additional strategy within the organised CC screening program is effective and cost- effective. Findings can be used to inform decision-makers and clinical guideline developers in Germany.

Disclosures This work was performed within the HaSCo Study (Hannoversche Self-Collection-Studie zur Prävention von Gebärmutterhalskrebs Studie) which was funded by the German Cancer Aid (Deutsche Krebshilfe).

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