What is the Most Cost-Effective way to Set-Up Organised Cervical Cancer Screening in France? a Budget Impact Analysis

Accordingly to the third Cancer plan, organized screening (OS) of cervical cancer among women aged 25-65 should be implemented in the forthcoming years in France. The most cost-effective way to implement OS in the French health care system in regard of this objective is yet to be determined. A budget impact model (BIM) was developed in collaboration with the French National Institute of Cancer (INCa) and an expert board involving clinical experts and stakeholder representatives (social security, ministry of health, patients and professionals). Time horizon of the analysis is three years. Five plausible scenarios aimed towards the whole non-participating population were assessed in the model. Those were derived from a basic scenario consisting of a mailed invitation followed by a mailed recall to which were added HPV DNA testing for women over 35, self-sampling kits sent to women over 35, pay for performance (P4P) incentives allocated to general practitioners (GP) whose eligible patients become participant, diversification of health professionals performing the sampling and full coverage of the screening by the statutory health insurance. The “full coverage scenario” is the most cost-effective, followed by the scenario with self-sampling kits sent to women, the scenario with increased diversity of the health professionals and the basic scenario. The costliest scenarios were the one implementing HPV DNA testing which did not provide further participation despite a high cost and the one based on P4P incentives towards GP, although it allows high participation rates. Using a comprehensive BIM, we show that full coverage of OS might be the most cost-effective way to implement it, although practical and financial issues might favour other scenarios that may be more balanced regarding the distribution of costs between stakeholders or may be more easily implemented and accepted by health professionals.