Abstract
Background: Cervical cancer is the third most common cancer in Thai women. Despite the national health benefit coverage of cervical cancer screening, its incidence and mortality rates are still high. The success of the screening policy is restrained due to various barrier factors that minimize the screening rate. Self-screening is one of the promising strategies that could reduce barriers to screening in Thai women. This study aimed to conduct (1) a systematic review of efficacy or effectiveness, cost-effectiveness, and acceptability; (2) cost-utility analysis; (3) budget impact analysis; and (4) feasibility analysis of cervical cancer screening policy by using a self-collected sample kit for HPV DNA test in Thailand. Methods: (1) A systematic search was conducted in 3 medical databases, i.e., Embase, MEDLINE, and PubMed on October 12th, 2022. The studies related to efficacy or effectiveness, cost-effectiveness, and acceptability or feasibility of cervical cancer screening by using a self-collected sample kit for HPV DNA test were included in the systematic review. (2) A cost-utility analysis of 3 options, i.e., (a) additional self-screening, (b) clinician screening only, and (c) no screening policies, was performed using a societal perspective. (3) budget impacts of the additional self-screening policy were calculated from a provider perspective. Lastly, (4) a feasibility study was done by in-depth interviewed medical professionals involved in cervical cancer screening and women who were the target group. Results: (1) Among 1,326 studies, 16 were included in the systematic review. There were 6 studies that reported screening performance of self-collected sample HPV DNA tests. Overall, the accuracy of screening by HPV DNA test using either self-collected or clinician-collected samples was similar, with approximately 74-91% sensitivity and 84-99% specificity when compared to the results of colposcopy at CIN2 or worse. There were 7 economic evaluation studies, all of which reported that self-screening was cost-effective. In addition, 3 feasibility studies found that majority of Thai women preferred self-screening to clinician screening. (2) Our cost-utility analysis revealed that the additional self-screening policy was the best-buy policy when compared among the three option. (3) The average budget impact per year of additional self-screening policy was around 723 million Thai baht. (4) Medical Professionals and the target group mostly accepted self-screening method. However, women who were at-risk or had gynecological symptoms should be examined by a clinician. Conclusions: In context of Thailand, additional self-screening policy for cervical cancer prevention was cost-saving compared to clinician screening only policy. The benefit of additional number of screened women predominated the incremental cost. Policy-makers should consider this evidence in the policy optimization process.
