ObjectiveThe purpose of this study was to identify patients within the Gloucestershire Diabetic Eye Screening Programme (DESP) over the age of 80 years at low risk of developing treatable diabetic retinopathy (DR).SettingThe county of Gloucestershire, UK.MethodsThis study evaluated treatment outcomes between August 2005 and December 2025 for patients who were negative for retinopathy and maculopathy at the last screen before their 80th birthday (group A) and had one negative screen post 80 years (group A1) or two negative screens post 80 (group A2), and patients without a prior history of DESP attendance before the age of 80 but with one negative screen post 80 (group B).ResultsIn group A1, 4713 patients had 26,446 subsequent screening episodes; 280 were referred, with 8 requiring intravitreal treatment (IVT) for diabetic macular oedema (DMO), 4 requiring laser therapy, and 1 requiring both. In group A2, 2264 patients had 13,602 subsequent screening episodes; 3 were referred but only 1 required IVT for DMO. In group B, 3867 patients had 17,447 subsequent screening episodes; 275 were referred but only 1 required IVT for DMO.ConclusionsPolicy makers should consider whether it is in the best interest of elderly patients with a very low risk of developing treatable DR (groups A2 and B) to continue to invite them for screening for the rest of their life as they become increasingly frail.
Objectives To estimate cervical screening coverage and inequities among Peruvian women aged 30–49 years and evaluate lifetime cost-utility and 5-year budget impact of scaling up HPV DNA testing, including self-sampling. Setting Peru, using national ENDES (Demographic and Family Health Survey) data and public sources. Methods We linked a cross-sectional ENDES 2015–2024 analysis to a public-payer decision model. Up-to-date screening was Pap or visual inspection with acetic acid within 3 years, or molecular HPV testing within 5 years. A screening decision tree and lifetime state-transition (Markov) model compared current practice with HPV self-sampling, clinician-collected testing, and hybrid expansion. We estimated costs, quality-adjusted life-years (QALYs), sequential incremental cost-effectiveness ratios (ICERs), probabilistic optimality, and budget impact at S/ 25,007 (Peruvian soles) / QALY. Results In 2024, 63.6% were up to date, 36.4% underscreened, 15.0% never screened, and 12.9% reported recent molecular HPV testing. The efficiency frontier was current practice, hybrid expansion to 90%, and clinician-collected HPV testing at 90%; sequential ICERs were S/ 5434 and S/ 10,982/QALY. In 5000 simulations, clinician-collected 90%, self-sampling 90%, and hybrid 90% had optimal-strategy probabilities of 69.46%, 15.46%, and 13.38%. Annualized budget impact was S/ 24.44 million for hybrid 90% and S/ 67.17 million for clinician-collected 90%. Conclusions Clinician-collected HPV testing at 90% maximized expected net monetary benefit under modeled assumptions, while hybrid expansion required less short-term expenditure. Policy should balance lifetime efficiency, feasibility, affordability, and linkage to diagnosis and treatment.
Background Self-sampling for high-risk human papillomavirus (hrHPV) testing has been introduced in cervical cancer screening programs to improve participation. In the Netherlands, women with an hrHPV-positive self-sample are required to visit their GP's office for cytology triage, as this cannot be performed on self-sampled material. Non-attendance at this step reduces screening effectiveness. This study examined whether sociodemographic and health-related behavioural factors commonly associated with screening participation are also associated with cytology triage attendance after an hrHPV-positive self-sample and whether these associations differ by age. Methods We conducted a study on the Lifelines cohort of participants in the Dutch cervical cancer screening program who used self-sampling between 2017 and 2024. The main outcome was cytology triage attendance within 6 months after an hrHPV-positive self-sample. Lifelines contains data on sociodemographic and behavioural factors including education, income, marital status, smoking, alcohol, diet, body mass index, physical activity, television viewing, sleep duration, lifetime use of hormonal contraception, parity, number of children and age at first childbirth. Logistic regression analyses were performed, including age-stratified models. Results Among women with an hrHPV-positive self-sample, 10.2% did not attend cytology triage within 6 months. Most sociodemographic and lifestyle factors were not associated with cytology triage attendance, and no meaningful differences were observed between age groups. However, inadequate prior screening history was associated with lower odds of cytology triage attendance. Conclusions The lack of associations with lifestyle or sociodemographic factors suggest that program-level strategies such as how hrHPV test results are communicated, might be more effective in increasing triage participation than interventions targeting specific subgroups.
