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Abstract Background Cervical cancer screening programs are established in most upper middle- and high-income countries (UMICs and HICs), yet many eligible women remain underscreened or unscreened. Human papillomavirus (HPV) testing by self-sampling (HPV-SS) has the potential to increase participation rates. In this study, we aim to systematically assess and synthesize the current evidence on cost-effectiveness of implementing HPV-SS in established cervical cancer screening programs in UMICs and HICs. Methods We searched relevant databases (until 02/2024) for studies on the cost-effectiveness of HPV-SS in cervical cancer screening in UMICs and HICs. Following PRISMA guidelines, we included empirical and decision-analytic modelling studies published in English or German reporting health-economic outcomes that can be expressed as incremental cost-effectiveness ratios (ICER). We extracted key study characteristics (e.g. target population, study type) and outcomes (e.g. ICER) and summarized them in systematic evidence tables. Costs were converted to 2024 Euro for cross-country comparison. Results Of 612 studies, 25 studies met inclusion criteria: 16 model-based cost-effectiveness evaluations and nine economic evaluations along trials. Studies were mainly conducted in HICs. HPV-SS was compared with standard care (e.g. clinician-collected conventional cytology, Pap smear, HPV-testing) or no screening. Eight studies assessed HPV-SS for all screening-eligible women, while 17 studies focused on women not attending regular screening. ICERs were reported in stepwise incremental fashion (i.e. comparing non-dominated strategy to the next non-dominated strategy) in 13 studies, and reported comparing each strategy to a reference each in ten studies. Overall HPV-SS was reported to be cost-effective or cost-saving compared to no screening or standard of care in all but one study. In non-attendees, ICERs ranged from being cost-saving for primary HPV screening with offering HPV-SS vs. not offering HPV-SS (Netherlands) to 60,000 Euro/LYG for a combined strategy (Pap smear until age 35 followed by 5-yearly HPV-SS until age 60) vs. no screening (Sweden). HPV-SS was shown to increase screening participation in studies evaluating screening attendance. Conclusion Based on our results, HPV-SS can be a practical, feasible and cost-effective approach to increase screening coverage. PROSPERO registration CRD42024499233.
Hallsson et al. (Sat,) studied this question.