Effectiveness and costs of an implemented primary HPV cervical screening programme in Sweden – A population based cohort study

•In an HPV-based cervical screening programme more HSIL + cases was detected but the clinical effectiveness comes with higher rates of colposcopy and clinical irrelevant findings.•In an HPV-based cervical screening programme two thirds of the cost, come from screening visits with sampling.•From a health economic perspective, our data emphasize the need for considering alterations in the screening programme including more specific triage analysis and the implementation of self-sampling.