Economic Evaluation of Mailed Home-Based Human Papillomavirus Self-sampling Kits for Cervical Cancer Screening.
Economic Evaluation of Mailed Home-Based Human Papillomavirus Self-sampling Kits for Cervical Cancer Screening.
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DOI：
10.1001/jamanetworkopen.2023.4052
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发表时间：
2023-03-01
影响因子：
13.8
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邮寄人乳头瘤病毒自我采样试剂盒相对于常规护理的成本效益是什么，以提高美国综合医疗保健系统中筛查不足的女性成员的宫颈癌筛查率？在这项涉及19851名来自随机临床试验的女性参与者的经济评价中，增加筛查摄取的增量成本效益比范围为每次额外完成筛查86美元至146美元。这些研究结果表明，在美国的私人综合卫生保健系统内，邮寄人乳头瘤病毒自我采样试剂盒给逾期未进行宫颈癌筛查的个人具有成本效益，可能是一种有效的推广策略，以提高合格妇女的筛查率。人乳头瘤病毒（HPV）自我采样解决了宫颈癌筛查的障碍，据报道，邮寄自我采样试剂盒增加了筛查的吸收。国际研究表明，邮寄工具包在某些情况下具有成本效益。然而，邮寄HPV自我采样试剂盒以增加筛查摄取的成本效益尚未在美国进行评估。在美国综合医疗保健系统中登记的筛查不足的妇女中进行邮寄HPV自我采样干预的经济评估。这项经济评价涉及对一项随机临床试验结果的成本效益分析，该试验纳入了19851名年龄在30至64岁之间的妇女，这些妇女参加了美国综合医疗保健系统Kaiser Permanente华盛顿（KPWA）的健康计划。通过电子病历识别女性，合格的参与者参加了至少3年零5个月的健康计划，有初级保健医生，至少3年零5个月没有接受过巴氏试验，并且没有接受过子宫切除术。入组时间为2014年2月25日至2016年8月29日，随访至2018年2月25日。本次经济评估于2021年8月2日至2022年7月30日期间进行。干预实施成本是从KPWA和医疗保险的角度计算的，并且基于健康就诊或仅Papanicolaou测试就诊成本。对照组的参与者接受常规护理，包括患者提醒和临时筛查外展。干预组的参与者接受常规护理加上邮寄的HPV自我采样试剂盒。主要经济学结果是增加筛查摄取的增量成本效果比（ICER），定义为成本增量差异（干预组减去对照组）除以随机化6个月内完成筛查的参与者数量差异（干预组减去对照组）。在19851名女性（平均[SD]年龄，50.1 [9.5]岁; 76.7%为白色）中，9960名随机分配至干预组，9891名随机分配至对照组。基线ICER的范围从85.84美元（95% CI，85.68 - 85.99美元）（使用KPWA健康访视作为成本基础）到146.29美元（95% CI，146.20 - 146.38美元）（使用Medicare Papanicolaou测试访视作为成本来源）。年龄在50至64岁之间的参与者亚组和最近逾期进行筛查的参与者亚组比其他亚组更愿意支付额外完成筛查的费用，从而实现了成本效益。在这项经济评估中，邮寄HPV自我采样试剂盒给逾期未进行宫颈癌筛查的妇女，相对于常规护理，增加筛查摄取具有成本效益。这些结果支持邮寄HPV试剂盒作为一种有效的外展策略，以提高美国卫生保健系统中符合条件的妇女的筛查率。这项经济评估使用随机临床试验的数据，以评估邮寄的人乳头瘤病毒自我采样试剂盒的成本效益，以增加在美国综合私营医疗保健系统中登记的筛查不足的妇女的筛查摄取。
What is the cost-effectiveness of mailing human papillomavirus self-sampling kits relative to usual care for increasing cervical cancer screening rates among underscreened female members of an integrated US health care system? In this economic evaluation involving 19 851 female participants from a randomized clinical trial, incremental cost-effectiveness ratios for increased screening uptake ranged from $86 to $146 per additional completed screening. These findings suggest that within US-based private integrated health care systems, mailing human papillomavirus self-sampling kits to individuals who are overdue for cervical cancer screening is cost-effective and may be an efficient outreach strategy to increase screening rates among eligible women. Human papillomavirus (HPV) self-sampling addresses barriers to cervical cancer screening, and mailed self-sampling kits have been reported to increase screening uptake. International research suggests mailed kits are cost-effective in certain settings. However, the cost-effectiveness of mailing HPV self-sampling kits for increasing screening uptake has not been evaluated in the US. To conduct an economic evaluation of a mailed HPV self-sampling intervention among underscreened women enrolled in an integrated US health care system. This economic evaluation involved a cost-effectiveness analysis of results from a randomized clinical trial of 19 851 women aged 30 to 64 years enrolled in a health plan from Kaiser Permanente Washington (KPWA), a US-based integrated health care system. Women were identified through electronic medical records, and eligible participants were enrolled in a health plan for at least 3 years and 5 months, had a primary care clinician, had not received a Papanicolaou test for at least 3 years and 5 months, and had not received a hysterectomy. Enrollment occurred from February 25, 2014, to August 29, 2016, with follow-up through February 25, 2018. The current economic evaluation was conducted between August 2, 2021, and July 30, 2022. Intervention delivery costs were calculated from both the KPWA and Medicare perspectives and were based on either wellness visit or Papanicolaou test–only visit costs. Participants in the control group received usual care, which comprised patient reminders and ad hoc outreach for screening. Participants in the intervention group received usual care plus a mailed HPV self-sampling kit. The primary economic outcome was the incremental cost-effectiveness ratio (ICER) for increased screening uptake, defined as the incremental difference in cost (intervention group minus control group) divided by the difference in the number of participants completing screening (intervention group minus control group) within 6 months of randomization. Among 19 851 women (mean [SD] age, 50.1 [9.5] years; 76.7% White), 9960 were randomized to the intervention group, and 9891 were randomized to the control group. Baseline ICERs ranged from $85.84 (95% CI, $85.68-$85.99) using KPWA wellness visits as the cost basis to $146.29 (95% CI, $146.20-$146.38) using Medicare Papanicolaou test–only visits as the cost source. Subgroups of participants aged 50 to 64 years and participants most recently overdue for screening achieved cost-effectiveness at lower levels of willingness to pay for an additional completed screening than other subgroups. In this economic evaluation, mailing HPV self-sampling kits to women overdue for cervical cancer screening was cost-effective for increased screening uptake relative to usual care. These results support mailing HPV kits as an efficient outreach strategy for increasing screening rates among eligible women in US health care systems. This economic evaluation uses data from a randomized clinical trial to assess the cost-effectiveness of a mailed human papillomavirus self-sampling kit for increasing screening uptake among underscreened women enrolled in an integrated private US health care system.