Assessing the theoretical cost of self-sampling using the Colli-Pee™ device for HPV screening in the U.K.

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cost of self-sampling using the Colli-Pee™ device

Article by: Sanna Abbasi, PhD

Evaluating cost is a critical factor in implementing changes in any national healthcare system. In their recent publication, Dr. Susie Huntington from Aquarius Population Health Limited (London, U.K.) and colleagues from the University of Manchester conducted a major health economics study featuring the Colli-Pee™ first-void urine collection device, manufactured by Novosanis NV, a subsidiary of OraSure Technologies, Inc. In their study, they compared the theoretical costs of different sampling strategies for human papillomavirus (HPV) primary screening in a simulated cohort of 10,000 women (aged 25-65) eligible for the National Health Service Cervical Screening Programme (NHSCSP). The focus of their research was to primarily evaluate the feasibility of self-sampling compared to current clinician-collected sampling.1 


The importance of cervical screening 


Cervical cancer is one of the leading causes of death worldwide for women and close to all cases of cervical cancer can be attributed to HPV infection.2 According to Cancer Research U.K., as of 2015, 99.8% of cervical cancer cases in the U.K. are preventable. Early detection by screening for high-risk HPV can be a preventative measure against cervical cancer. Unsurprisingly, the success of any screening program is reliant on high patient participation rates. 


Annual routine screening programs—such as the NHSCSP in the U.K.—rely on patients seeing their general practitioner and consenting to provide a clinician-collected cervical sample. This sample is typically collected using an invasive cervical brush. The collected sample is then sent to laboratories for HPV testing and, if positive for high-risk HPV, the patient is asked to undergo an invasive colposcopy procedure to verify the HPV-positive diagnosis.  


Study design to assess cost of various sampling strategies 


The health-economic research study titled, Two self-sampling strategies for HPV primary cervical cancer screening compared with clinician-collected sampling: an economic evaluation”, conducted by Huntington et al. (2023) was recently published in the biomedical journal, BMJ Open. Huntington et al. implemented a design based on the NHSCSP (which normally uses clinician-collected cervical samples) and adapted the procedure for self-sampling. Using real-world evidence, three different cervical sampling strategies were assessed in the study:  


  1. Routine clinician-collected cervical sampling 

  1. Self-collected first-void urine 

  1. Self-collected vaginal swab 


As a hypothetical model, the parameter inputs were inferred using NHSCSP reports, published studies, and insight from sample collection device manufacturers and experts. In the model, the two self-sampling strategies would have involved mailing enrolled women a sampling kit. In the study, both primary and secondary outcomes were assessed: 


  • Primary outcomes:  

  • Overall costs (for all screening steps up to colposcopy) 

  • Number of complete screens 

  • Cost per complete screen 


  • Secondary outcomes: 

  • Number of women screened 

  • Number of women lost to follow-up 

  • Cost per colposcopy 

  • Total screening costs for a plausible range of uptake scenarios 


Study indicates that self-sampling using the Colli-Pee™ device for HPV screening is both cost effective and could improve patient access 


Between the three different cervical sampling strategies, for the base patient case, the average cost per complete screen was £56.81 for a clinician-collected cervical sample, £38.57 for first-void urine self-collected sample (collected using the Colli-Pee™ device), and £40.37 for a vaginal self-collected sample. These results suggest that clinician-collected cervical sampling was the most expensive option while self-collected first-void urine via the Colli-Pee™ device was the least expensive option.  





Notably, both self-sampling options were less expensive compared to routine clinician-collected sampling. The two variables with the greatest effect on the average cost per screen were the cost of sample collection for clinician-collected samples and the cost of laboratory HPV testing for the two self-sampling options. 


These results imply that self-sampling, especially with the Colli-Pee™ device, could be a more affordable alternative for cervical sampling needs. The research conducted here provides insight into the cost-effectiveness of self-sampling for routine HPV cervical cancer screening and suggests that if self-screening led to an increase in both access and compliance by women, the NHSCSP could save millions of pounds per year. 




Based on the study findings, self-sampling—in comparison to clinician-collected sampling—may be a less costly alternative for routine HPV screening. As self-sampling is compatible with mailing, it also allows healthcare professionals to expand the reach of cervical cancer screening to under-screened women or those residing in more remote locations. 


Because of the COVID-19 pandemic, self-sampling and self-testing are now seeing more widespread use and both could contribute to future changes in our national healthcare systems. Once again, as a consequence of the global pandemic, we have witnessed a preference among users for less invasive screening procedures. For these reasons, first-void urine collection could be the preferred self-sampling method for HPV screening aside from being the least costly, but future studies will be needed to evaluate preferences and efficacies. 


The current study only hypothetically assessed cost in a simulated cohort of women and made the major assumption that HPV testing of self-collected samples will perform equally to clinician-collected samples. Although several studies already do indicate similar performance when comparing self-sampling and clinician-collected samples,3,4 future research could also assess the diagnostic accuracy of self-sampling versus clinician-collected samples (e.g., rate of false positives, false negatives, sample failure rate, etc.).  



  1. Huntington S, Sudhir KP, Schneider V, Sargent A, Turner K, Crosbie EJ, Adams EJ. (2023) Two self-sampling strategies for HPV primary cervical cancer screening compared with clinician-collected sampling: an economic evaluation. BMJ Open. doi: 10.1136/bmjopen-2022-068940 

  1. Davies-Oliveira JC, Smith MA, Grover S, Canfell K, Crosbie EJ. (2021) Eliminating cervical cancer: progress and challenges for high-income countries. Clin Oncol (R Coll Radiol). doi: 10.1016/j.clon.2021.06.013 


  1. Sargent A, Fletcher S, Bray K, Kitchener HC, Crosbie EJ. (2019) Cross-sectional study of HPV testing in self-sampled urine and comparison with matched vaginal and cervical samples in women attending colposcopy for the management of abnormal cervical screening. BMJ Open. doi: 10.1136/bmjopen-2018-025388 


  1. Cho HW, Shim SR, Lee JK, Hong JH. (2022) Accuracy of human papillomavirus tests on self-collected urine versus clinician-collected samples for the detection of cervical precancer: a systematic review and meta-analysis. J Gynecol Oncol. doi: 10.3802/jgo.2022.33.e4