{
  "abstract": "Objectives: To evaluate the clinical yield and operational costs of a targeted ‘send-to-all’ human papillomavirus (HPV) self-sampling strategy for long-term non-attenders in cervical cancer screening.\n\nDesign: Population-based, real-world observational registry study.\n\nSetting: The regional organised cervical cancer screening programme in Region Örebro County, Sweden.\n\nParticipants: A total of 9123 women identified as long-term non-attenders. Long-term non-attendance was defined as having no recorded cervical screening test for at least one routine screening interval plus an additional 4 years.\n\nInterventions: A total of 11 283 vaginal HPV self-sampling kits were dispatched via direct mail to the registered home addresses of all 9123 eligible women between 2022 and 2024.\n\nPrimary and secondary outcome measures: Clinical yield was evaluated using the number of tests analysed (NTA) and number of kits dispatched (NKD) to detect one case of high-grade squamous intraepithelial lesion or worse (HSIL+). Resource utilisation was measured as the average cost per screened woman/detected HSIL+, and the economic break-even point against standard letter invitations was established using a deterministic threshold analysis.\n\nResults: Of the 11 283 self-sampling kits dispatched, 1826 kits were returned and analysed. This direct response yielded 27 HSIL+ cases (NTA: 68; NKD: 418), at an average cost of 2031 SEK (€183) per screened woman and 134 103 SEK (€12,114) per histologically confirmed HSIL+ case. Incorporating an additional 190 long-term non-attenders who underwent clinical screening within 1 year of dispatch yielded a total of 32 HSIL+ cases. This cumulative response decreased the NTA to 63 and the NKD to 353, with an average cost of 2045 SEK (€185) per screened woman and 126 068 SEK (€11 388) per HSIL+ case. To match the cost per screened woman of the self-sampling strategy, standard letter invitations must achieve a participation rate of 9.5% (based on kit returns alone) or 6.4% (based on cumulative participation).\n\nConclusions: Direct mailing of HPV self-sampling kits effectively identifies high-grade lesions in a hard-to-reach population. From an operational perspective, previous research indicates that participation from standard letters rarely reaches the calculated 6.4%–9.5% break-even points, suggesting self-sampling is a resource-efficient initial outreach strategy for long-term non-attenders. However, full economic evaluations incorporating long-term health outcomes are required to establish comprehensive cost-effectiveness.",
  "abstract_shown": true,
  "affiliations": [
    "University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden",
    "Department of Women’s Health, Faculty of Medicine and Health, Örebro University, Örebro, Sweden",
    "Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden",
    "School of Health Sciences, Örebro University, Örebro, Sweden"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Jasmine Fridljung",
      "orcid": "0009-0007-1918-7724"
    },
    {
      "affs": [
        1
      ],
      "name": "Lovisa Bergengren"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Gabriella Lillsunde-Larsson"
    },
    {
      "affs": [
        0
      ],
      "name": "Linda Ryen"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/fw2m50w17fq2m.bib",
  "cited_by": 0,
  "doi": "10.1136/bmjopen-2026-125034",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13711516/",
  "id": "fw2m50w17fq2m",
  "issns": [
    "2044-6055",
    "2044-6055"
  ],
  "landing_url": "https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-125034",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "1506"
    ],
    [
      "heading",
      "1701"
    ],
    [
      "heading",
      "Health Economics"
    ],
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "2713|Cervical Cancer and HPV Research"
    ]
  ],
  "openalex": "W7223203760",
  "pdf_url": "https://bmjopen.bmj.com/content/bmjopen/16/10/e125034.full.pdf",
  "pmcid": "PMC13711516",
  "pmid": "42914540",
  "published": "2026-10-22",
  "publisher": "BMJ",
  "ris": "https://research.draconitic.com/paper/fw2m50w17fq2m.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:44Z",
      "native_id": "10.1136/bmjopen-2026-125034",
      "source": "crossref",
      "url": "https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-125034"
    },
    {
      "first_seen": "2026-10-31T12:22:17Z",
      "native_id": "PMC13711516",
      "source": "pmc",
      "url": "https://doi.org/10.1136/bmjopen-2026-125034"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2713|Cervical Cancer and HPV Research",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Clinical yield and operational cost-threshold analysis of HPV self-sampling send-outs for long-term non-attenders in cervical cancer screening: a population-based, real-world, registry study in Sweden",
  "title_text": "Clinical yield and operational cost-threshold analysis of HPV self-sampling send-outs for long-term non-attenders in cervical cancer screening: a population-based, real-world, registry study in Sweden",
  "type": "peer-reviewed",
  "updated_at": "2026-10-31T12:22:17Z",
  "url": "https://research.draconitic.com/paper/fw2m50w17fq2m",
  "venue": "BMJ Open",
  "versions": []
}