{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T08:51:33Z","timestamp":1773391893774,"version":"3.50.1"},"reference-count":32,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl Journal of Cancer"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>High\u2010risk Human Papillomavirus self\u2010sampling can increase attendance rates for screening. However, observed lower sensitivity and loss to follow\u2010up of self\u2010sampling could reduce programme effectiveness when attenders of clinician\u2010collected sampling switch to self\u2010sampling. We determined the tipping point for effectiveness (based on life years gained [LYG]) of self\u2010sampling and the consequences for cost\u2010effectiveness, taking into account waste by comparing full opt\u2010out (no waste) to no opt\u2010out (waste from unused self\u2010sampling kits). We used the STDSIM\u2010MISCAN\u2010Cervix microsimulation model to simulate a population of Dutch women born in 2000 (50% vaccinated [sensitivity analysis: 0\u2013100%], 70% screening attendance [sensitivity analysis: 60\u201380%]). Self\u2010sampling deployment strategies (e.g., direct\u2010mail) were varied by the percentage of original attenders switching to self\u2010sampling and the percentage of new attendance from non\u2010attenders. Main outcome measures were LYG and cost\u2010effectiveness (cost per quality adjusted [QA] LY gained) compared to the current programme. We found that if self\u2010sampling does not reach non\u2010attenders, life years cannot be gained. When reaching 10% or 30% of non\u2010attenders, the tipping point lies at \u226440% and \u2264100% switchers to maintain effectiveness, respectively (+4 LYG, +10 LYG). Scenarios were cost\u2010effective (&lt;\u20ac50,000\/QALY gained) if at least 10% of non\u2010attenders were reached. Full opt\u2010out improved cost\u2010effectiveness substantially. So, in a partly vaccinated population, self\u2010sampling deployment strategies need to reach at least 10% of non\u2010attenders to maintain programme effectiveness and cost\u2010effectiveness. A well\u2010functioning opt\u2010out system further improves cost\u2010effectiveness by preventing waste.<\/jats:p>","DOI":"10.1002\/ijc.70184","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T13:40:48Z","timestamp":1760017248000},"page":"1361-1369","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Under which realistic circumstances is\n                    <scp>hrHPV<\/scp>\n                    self\u2010sampling increasing cervical screening effectiveness in a partly vaccinated population? A modelling study"],"prefix":"10.1002","volume":"158","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7289-403X","authenticated-orcid":false,"given":"Sylvia","family":"Kaljouw","sequence":"first","affiliation":[{"name":"Department of Public Health Erasmus MC, University Medical Center Rotterdam  Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0436-6918","authenticated-orcid":false,"given":"Erik E. L.","family":"Jansen","sequence":"additional","affiliation":[{"name":"Department of Public Health Erasmus MC, University Medical Center Rotterdam  Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5549-6216","authenticated-orcid":false,"given":"Ellen M. G.","family":"Olthof","sequence":"additional","affiliation":[{"name":"Department of Public Health Erasmus MC, University Medical Center Rotterdam  Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9323-7861","authenticated-orcid":false,"given":"Jan A. C.","family":"Hontelez","sequence":"additional","affiliation":[{"name":"Department of Public Health Erasmus MC, University Medical Center Rotterdam  Rotterdam The Netherlands"},{"name":"Heidelberg Institute of Global Health Universit\u00e4tsklinikum Heidelberg  Heidelberg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9419-0452","authenticated-orcid":false,"given":"Inge M. C. M.","family":"de Kok","sequence":"additional","affiliation":[{"name":"Department of Public Health Erasmus MC, University Medical Center Rotterdam  Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"key":"e_1_2_12_2_1","first-page":"228","article-title":"Introduction of primaryscreening using high\u2010risk HPV DNA detection in the Dutch cervicalcancer screening programme: a population\u2010based cohort study","volume":"17","author":"Aitken CA","year":"2019","journal-title":"BMCMed"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.28545"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c1040"},{"key":"e_1_2_12_5_1","volume-title":"Monitor bevolkingsonderzoek baarmoederhalskanker 2021","author":"RIVM","year":"2022"},{"key":"e_1_2_12_6_1","volume-title":"Monitor bevolkingsonderzoek baarmoederhalskanker 2020","author":"RIVM","year":"2021"},{"key":"e_1_2_12_7_1","volume-title":"Uitval in Het Baarmoederhalskanker Bevolkingsonderzoek","author":"Olthof EMG","year":"2020"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2021.100235"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k4823"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2015.07.006"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.5842"},{"key":"e_1_2_12_12_1","volume-title":"Rijksvaccinatieprogramma jaarverslag 2011","author":"Rijksinstituut voor Volksgezondheid en Milieu (RIVM)","year":"2012"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0116618"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-022-02631-7"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.16400"},{"key":"e_1_2_12_16_1","volume-title":"Bevolking; 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