Table 1 Resource required for screening a population of 100,000 women in three different invitation strategies (costs included per strategy marked by ‘x’). Estimates on self-sampling as a second reminder with two different follow-up strategies after a hrHPV-positive self-taken sample. For total costs per invitational strategy, see Table 2. Flow-chart on invitational strategies as Fig. 1

x

x

x

x

Primary invitation

1.00

100,000

100,000

x

x

x

x

Pap-smear for attendees (70 %)

29.80

70,000

2,086,000

http://www.cancerregistry.fi/statistics, [25]

Diagnostic colposcopy

630

Average national rate of referrals for diagnostic confirmations, 0.9 % of attendees

http://www.cancerregistry.fi/statistics

x

x

x

x

No CIN diagnosis^a

1,047.10

350

366,485

[25]

x

x

x

x

CIN1 case, inlc. treatment and follow-up^b

1,863.40

70

130,438

Average national yield of CIN1/CIN2+ lesions, 0.1 %/0.3 % of attendees

http://www.cancerregistry.fi/statistics, [25]

x

x

x

x

CIN2+ case, inlc. treatment and follow-up^b

2,512.00

210

527,520

http://www.cancerregistry.fi/statistics, [25]

x

x

x

Reminder letter

0.75

30,000

22,500

x

x

x

Pap-smear for attendees (27 %)

29.80

8,100

241,380

[12, 14, 25]

Referral for diagnostic colposcopy

110

The pooled rate of referrals among attendees by reminder letter in the studies; 1.4 % (50/3,688)

[12, 14]

x

x

x

No CIN diagnosis^a

1,047.10

55

57,591

[25]

x

x

x

CIN1 case, inlc. treatment and follow-up^b

1,863.40

11

20,497

The pooled yields of CIN lesions among participants after 1st reminder in the studies; 0.1 % for CIN1 (6/4,444) and 0.5 % for CIN2+ (24/4,444)

[12, 14, 25]

x

x

x

CIN2+ case, inlc. treatment and follow-up^b

2,512.00

44

110,528

[12, 14, 25]

x

Sampling device^c

2.00/6.50

30,000

60,000–195,000

x

Information/invitation letter

0.75

30,000

22,500

x

Outbound mailing and other logistic costs^c

2.90

30,000

87,000

x

Inbound mailing costs for attendees (32 %)

1.20

9,600

11,520

[12]

x

HrHPV analysis for attendees (32 %)

20.00

9,600

192,000

[12]

x

Response letter for attendees

0.75

9,600

7,200

Invitation for follow-up Pap-smear (hrHPV-positives)

1,152

12 % test positivity rate

[12, 14]

x

Follow-up Pap-smear

29.80

945

28,161

82 % compliance to follow-up

[12, 14, 25]

Refererral for diagnostic colposcopy

210

The rate of colposcopies after Pap-smear triage in the first study, 22.2 % (6/27 Pap-smears taken)

[12]

x

No CIN diagnosis^a

1,047.10

156

163,348

[25]

x

CIN1 case, inlc. treatment and follow-up^b

1,863.40

11

20,497

The yield of CIN lesions among attendees after 1st reminder in the studies (see above), but accounting for 18 % loss in follow-up

[12, 14, 25]

x

CIN2+ case, inlc. treatment and follow-up^b

2,670.30

43

114,823

[12, 14, 25]

x

x

Sampling device^c

2.00/6.50

21,900

43,800-142,350

x

x

Information/invitation letter

0.75

21,900

16,425

x

x

Outbound mailing and other logistic costs^c

2.90

21,900

63,510

x

x

Inbound mailing costs for attendees (21 %)

1.20

4,599

5,519

[12, 14]

x

x

HrHPV analysis for attendees (21 %)

20.00

4,599

91,980

[12, 14]

x

x

Response letter for attendees

0.75

4,599

3,449

  Invitation for follow-up Pap-smear (hrHPV-positives)

552

12 % test-positivity rate

x

  Follow-up Pap-smear

29.80

436

12,993

79 % compliance to follow-up

[12, 14, 25]

x

  Referral for diagnostic colposcopy

83

Pooled rate of referrals after Pap-smear triage in the studies, 19.1 % (9/47 Pap-smears taken)

[12, 14]

x

  No CIN diagnosis^a

1,047.10

25

26,178

[25]

x

  CIN1 case, inlc. treatment and follow-up^b

1,863.40

27

50,312

The pooled yield of CIN lesions among test positive participants compliant to follow-up in the studies; 6.1 % for CIN1 (7/114) and 7.0 % for CIN2+ (8/114)

[12, 14, 25]

x

  CIN2+ case, inlc. treatment and follow-up^b

2,670.30

31

82,779

[12, 14, 25]

 Follow-up: direct colposcopy

  Referral for direct colposcopy for hrHPV-positives

552

12 % test-positivity rate

[14]

x

  No CIN diagnosis^a

1,047.10

432

452,347

90 % compliance to follow-up

x

  CIN1 case, inlc. treatment and follow-up^b

1,863.40

30

55,902

[12, 14, 25]

x

  CIN2+ case, inlc. treatment and follow-up^b

2,670.30

35

93,461

[12, 14, 25]