Cost and cost-effectiveness of cervical cancer HPV DNA self-sampling: a systematic review.

Objective: To gather evidence on the costs and cost-effectiveness of human papillomavirus DNA (HPV DNA) self-sampling worldwide and to determine whether these are influenced by the various HPV DNA self-sampling strategies employed. Design: A systematic review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data sources: Articles were searched from Embase, Medline (Ovid), PubMed and EconLit, published from 2015 to 2025. Eligibility criteria: Women eligible for cervical cancer screening. Studies on the economic evaluation of HPV DNA self-sampling worldwide. Peer-reviewed original articles published in English from 2015 to October 2025. Data extraction: Data were extracted using the authors' developed template. Analysis was done descriptively, applying synthesis without meta-analysis (SWiM). Results: 33 studies were included in 11 low- and middle-income countries (LMICs) and 9 high-income countries (HICs). Most studies (N=18) targeted women from the general population and 10 under/never-screeners. The HPV DNA self-sampling strategies include: opt-in, opt-out, point of care and community health campaigns. Community health campaigns were predominant in LMICs, while opt-in and opt-out in HICs. The cost per woman screened reported in micro-costing/cost-consequence analysis studies ranged from US$31.77 to US$72.20 in LMICs and from US$56.21 to US$78.34 in HICs. 21/23 studies found HPV DNA self-sampling strategies to be cost-effective/cost-saving: 11/12 from LMICs and 10/11 from HICs. Conclusions: Community health campaigns and point-of-care HPV DNA self-sampling strategies in LMICs and opt-in and opt-out in HICs are cost-effective. Implementation studies are recommended, especially for populations at high risk. PROSPERO registration number: CRD42024518867.