Mailed HPV test kits are cost-effective for screening

Study provides economic rationale for health systems to adopt mailed kits for cervical cancer screening

Mailing human papillomavirus (HPV) self-test kits to patients is an effective and affordable way to boost cervical cancer screening rates.  

These findings, published in JAMA Network Open, come from a new study conducted at Kaiser Permanente Washington. This is the first study within a U.S.-based health system to examine the cost-effectiveness of these mailing strategies across different patient groups, including those who are up to date on screening or overdue.

What do we know already?

Nearly all cervical cancers are caused by prolonged infection with high-risk strains of HPV. Studies show that self-sampling test kits are effective at detecting the virus, helping to identify precancers so they can be removed. The kits also offer a convenient option for screening, as they can be done at home without a trip to a clinic.

“There are lots of barriers to screening, including lack of transportation or time, and embarrassment or discomfort,” said Beverly Green, MD, MPH, a senior investigator at Kaiser Permanente Washington Health Research Institute (KPWHRI) who is a family physician and preventive health researcher. “Home tests can help overcome some of those obstacles.” 

Earlier research co-led by Green and published in JAMA found that mailing HPV test kits directly to patients significantly increased cervical cancer screening rates. In the new study, Green and colleagues turned their attention to evaluating the cost-effectiveness of mailed HPV kits compared with other strategies to increase screening.

What did the new study find? 

The study looked at more than 31,000 Kaiser Permanente Washington members ages 30 to 64 between November 2020 and July 2022. The researchers assessed different patient groups based on their screening history, including those who were up to date (screening adherent) or overdue. Within each group, patients were randomly assigned to different screening approaches, such as a mailed HPV test kit option, reminders to receive in-clinic screening (usual care), or usual care plus mailed educational materials about screening.

• For screening-adherent patients, directly mailing HPV test kits was more effective and cost-saving than usual care, both with and without educational materials.
• For overdue patients, directly mailing kits was also more effective than usual care, both with and without educational materials, and was either cost-saving or associated with a minimal additional cost.

A budget impact analysis found that while the initial program budget for mailing kits to screening-adherent patients was the largest, it also declined the fastest, becoming the lowest after 4 years.

"Mailed HPV self-sampling kits have been shown to increase screening rates, but there are limited data on the cost-effectiveness of this approach in the U.S.," said the study's senior author Rachel Winer, PhD, MPH, a KPWHRI affiliate investigator and professor at the University of Washington School of Public Health. "Our findings provide a strong economic justification for health systems to implement mailed HPV self-sampling within their cervical cancer programs, especially since they can reach a wide range of patients."

Kaiser Permanente Washington is one health system that has adopted this approach — it has offered mailed HPV self-sampling kits as a standard option for cervical cancer screening since the summer of 2023.

This research was supported by the National Cancer Institute, part of the National Institutes of Health. 

Melissa Anderson, MS, a principal collaborative biostatistician with KPWHRI, was a coauthor on this study.