{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T05:40:02Z","timestamp":1791265202662,"version":"4.1.0"},"reference-count":83,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2023,6,6]],"date-time":"2023-06-06T00:00:00Z","timestamp":1686009600000},"content-version":"unspecified","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"OraSure Technologies Incorporated","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,4,25]]},"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the costs and effects of three sampling strategies for human papillomavirus (HPV) primary screening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cost-consequence analysis from a health system perspective using a deterministic decision tree model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>England.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A cohort of 10\u2009000\u2009women aged 25\u201365 years eligible for the National Health Service Cervical Screening Programme (NHSCSP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The model was based on the NHSCSP HPV primary screening pathway and adapted for self-sampling. It used a 3-year cycle: routine screening (year 1) and recall screening (years 2\/3). Parameter inputs were informed using published studies, NHSCSP reports and input from experts and manufacturers. Costs were from 2020\/2021, British pound sterling (\u00a3).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Three sampling strategies were implemented: (1) routine clinician-collected cervical sample, (2) self-collected first-void (FV) urine, (3) self-collected vaginal swab. The hypothetical self-sampling strategies involved mailing women a sampling kit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Primary outcomes: overall costs (for all screening steps to colposcopy), number of complete screens and cost per complete screen. Secondary outcomes: number of women screened, number of women lost to follow-up, cost per colposcopy and total screening costs for a plausible range of uptake scenarios.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the base case, the average cost per complete screen was \u00a356.81 for clinician-collected cervical sampling, \u00a338.57 for FV urine self-sampling and \u00a340.37 for vaginal self-sampling. In deterministic sensitivity analysis, the variables most affecting the average cost per screen were the cost of sample collection for clinician-collected sampling and the cost of laboratory HPV testing for the self-sampling strategies. Scaled to consider routine screening in England, if uptake in non-attenders increased by 15% and 50% of current screeners converted to self-sampling, the NHSCSP would save \u00a319.2\u2009million (FV urine) or \u00a316.5\u2009million (vaginal) per year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Self-sampling could provide a less costly alternative to clinician-collected sampling for routine HPV primary screening and offers opportunities to expand the reach of cervical screening to under-screened women.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-068940","type":"journal-article","created":{"date-parts":[[2023,6,7]],"date-time":"2023-06-07T03:56:57Z","timestamp":1686110217000},"page":"e068940","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":28,"title":["Two self-sampling strategies for HPV primary cervical cancer screening compared with clinician-collected sampling: an economic evaluation"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2854-7441","authenticated-orcid":false,"given":"Susie","family":"Huntington","sequence":"first","affiliation":[{"name":"Aquarius Population Health, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7787-0333","authenticated-orcid":false,"given":"Krishnan","family":"Puri Sudhir","sequence":"additional","affiliation":[{"name":"Aquarius Population Health, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Verena","family":"Schneider","sequence":"additional","affiliation":[{"name":"Aquarius Population Health, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Sargent","sequence":"additional","affiliation":[{"name":"Cytology Department, Clinical Sciences Centre, Manchester University NHS Foundation Trust, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katy","family":"Turner","sequence":"additional","affiliation":[{"name":"Aquarius Population Health, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0284-8630","authenticated-orcid":false,"given":"Emma J","family":"Crosbie","sequence":"additional","affiliation":[{"name":"Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK"},{"name":"Department of Obstetrics and Gynaecology, St Mary\u2019s Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth J","family":"Adams","sequence":"additional","affiliation":[{"name":"Aquarius Population Health, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,6,6]]},"reference":[{"key":"2025121508295231000_13.6.e068940.1","unstructured":"World Health Organization . 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