. 2015 Nov 5;15:99. doi: 10.1186/s12905-015-0261-7

Table 2.

Total resource required for screening and cost per detected and treated CIN2+ lesion (in euros). Estimates in self-sampling as a 2nd reminder for two different follow-up strategies after a hrHPV-positive self-taken sample. In the main estimate, sampler price is at 2.0 euros and cost of hrHPV-analysis at 20.0 euros. For breakdown of costs, see Table 1

	Primary invitation only	One reminder		Two reminders
	Primary invitation only	Reminder by self-sampling	Reminder by reminder letter	Reminders by reminder letter & self-sampling	Reminders by reminder letter & self-sampling
		Follow-up^a: Pap-smear triage, compliance 82 %		Follow-up^a: Pap-smear triage, compliance 79 %	Follow-up^a: direct colposcopy, compliance 90 %
Primary invitation
Cost per screened woman (prim. testing^b)	31	31	31	31	31
Total costs	3,210,443	3,210,443	3,210,443	3,210,443	3,210,443
Cost per treated CIN2+	15,288	15,288	15,288	15,288	15,288
1st reminder
Cost per screened woman (prim. testing^b)		43	33	33	33
Total costs		707,049	452,496	452,496	452,496
Cost per extra treated CIN2+		16,443	10,284	10,284	10,284
2nd reminder
Cost per screened woman (prim. testing^b)				53	50
Total costs				396,944	826,393
Cost per extra treated CIN2+				12,805	23,611
Total costs of screening
Cost per screened woman (prim. testing^b)	31	33	31	33	32
Total costs	3,210,443	3,917,492	3,662,939	4,059,883	4,489,332
Cost per treated CIN2+	15,288	15,484	14,421	14,245	15,534
Total cost increase by reminders	-	22 %	14 %	26 %	40 %
Achieved attendance rate	70.0 %	79.4 %	78.1 %	82.6 %	82.6 %
Increase in CIN2+ detection		20 %	21 %	36 %	38 %
Additional analysis:
Self-sampling opt-out rate 15 %
Cost per screened woman (prim. testing^b)		41		49	47
Cost per detected CIN2+ (by reminder)		15,930		12,285	23,175
Sampler price = 6.5 euros
Cost per screened woman (prim. testing^b)		58		75	72
Cost per CIN2+ lesion (by reminder)		19,583		15,984	26,427
Cost per CIN2+ lesion (total)		16,018		14,591	15,875
Cost of HPV-analysis = 15–30 euros
Cost per screened woman (prim. testing^b)		38–54		48–63	45–60
Cost per CIN2+ lesion (by reminder)		15,327–18,676		12,063–14,288	22,954–24,925
Cost per CIN2+ lesion (total)		15,294–15,864		14,165–14,407	15,454–15,693
Sampler price = 6.5 euros & cost of HPV-analysis = 30 euros
Cost per screened woman (prim. testing^b)		68		85	82
Cost per CIN2+ lesion (by reminder)		21,815		17,467	27,741
Cost per CIN2+ lesion (total)		16,397		14,752	16,034
Compliance to Pap-smear triage = 70 %
Cost per CIN2+ lesion (by reminder)		18,553		13,966
Cost per CIN2+ lesion (total)		15,766		14,377
Compliance to Pap-smear triage = 70 % & cost of HPV-analysis 30 euros & sampler price = 6.5 euros
Cost per CIN2+ lesion (by reminder)		24,970		19,320
Cost per CIN2+ lesion (total)		16,705		14,892
CIN yield by self-sampling +20 % compared to reminder letter (1.2 x yield by reminder letter)
Cost per CIN2+ lesion (by reminder)		14,150
Cost per CIN2+ lesion (total)		15,066
CIN yield by self-sampling +50 % compared to reminder letter (1.5 x yield by reminder letter)
Cost per CIN2+ lesion (by reminder)		11,644
Cost per CIN2+ lesion (total)		14,421
Reminder letter participation rate = 14 %
Cost per CIN2+ lesion			10,693
Increase in costs by reminders			7.7 %
Increase in CIN2+ detection (total)			11.0 %

Assuming 70 % attendance rate with the primary invitation, 27/32 % attendance with first reminder (reminder letter/self-sampling, respectively), and 21 % attendance rate with self-sampling as second reminder

^a Follow-up for women with a HPV-positive result from the self-taken sample

^b including only costs of invitations, primary screening test and possible triage testing