The cost-effectiveness of opt-in and send-to-all HPV self-sampling among long-term non-attenders to cervical cancer screening in Norway : The Equalscreen randomized controlled trial

OBJECTIVE: We assessed the cost-effectiveness of mailing a human papillomavirus self-sampling (HPV-ss) kit, directly or via invitation to order, compared with mailing reminder letters among long-term non-attenders in Norway. METHODS: We conducted a secondary analysis using the Equalscreen study data with 6000 women aged 35-69 years who had not screened in 10+ years. Participants were equally randomized into three arms: reminder letter (control); invitation to order HPV-ss kit (opt-in); directly mailed HPV-ss kit (send-to-all). Cost-effectiveness (2020 Great British Pounds (GBP)) was estimated using incremental cost-effectiveness ratios (ICERs) per additional screened woman, and per additional cervical intraepithelial neoplasia grade 2 or worse (CIN2+) from extended and direct healthcare perspectives. RESULTS: Participation, CIN2+ detection, and total screening costs were highest in the send-to-all arm, followed by the opt-in and control arms. Non-histological physician appointments contributed to 67% of the total costs in the control arm and ≤ 31% in the self-sampling arms. From an expanded healthcare perspective, the ICERs were 135 GBP and 169 GBP per additional screened woman, and 2864 GBP and 4165 GBP per additional CIN2+ detected for the opt-in and send-to-all, respectively. CONCLUSIONS: Opt-in and send-to-all self-sampling were more effective and, depending on willingness-to-pay, may be considered cost-effective alternatives to improve screening attendance in Norway

A highly hydroxide conductive, chemically stable anion exchange membrane, poly(2,6 dimethyl 1,4 phenylene oxide)-b-Poly(vinyl benzyl trimethyl ammonium), for electrochemical applications

A chemically stable copolymer [poly(2,6 dimethyl 1,4 phenylene oxide)-b-poly(vinyl benzyl trimethyl ammonium)] with two ion exchange capacities, 3.2 and 2.9 meq g-1, was prepared as anion exchange membranes (AEM-3.2 and AEM-2.9). These materials showed high OH-conductivities of 138 mS.cm-1 and 106 mS.cm-1, for AEM-3.2 and AEM-2.9 respectively, at 60\ub0C, and 95% RH. The OH-conductivity = 45 mS.cm-1 for AEM-3.2 at 60% RH and 60\ub0C in the absence of CO2. Amongst the ions studied, only OH-is fully dissociated at high RH. The lower Ea = 10-13 kJ.mol-1 for OH-compared to F- 3c 20 kJ.mol-1 in conductivity measurements, and of H2O from self-diffusion coefficients suggests the presence of a Grotthuss hopping transport mechanism in OH-transport. PGSE-NMR of H2O and F-show that the membranes have low tortuosity, 1.8 and 1.2, and high water self-diffusion coefficients, 0.66 and 0.26 7 10 cm2.s-1, for AEM-3.2 and AEM-2.9 respectively. SAXS and TEM show that the membrane has several different sized water environments, ca. 62 nm, 20 nm, and 3.5 nm. The low water uptake, "k = 9-12, reduced swelling, and high OH-conductivity, with no chemical degradation over two weeks, suggests that the membrane is a strong candidate for electrochemical applications

Thin robust anion exchange membranes for fuel cell applications

Extensive transport and modeling studies have been performed on a series of polymers based on the benzyltrimethylamonium cations. We have created a realistic reactive model of solvated hydroxide that has interesting properties in the polymer matrix. In ordered di-block polymers we have strong theoretical evidence for a heterogeneous distribution of water across the channel. Fluoride is used as a non-reactive surrogate for hydroxide to increase the computational efficiency of transport calculations that can be performed. In addition to these studies we are discovering new base stable processable robust polymer backbones and cations. These bulky cations seem to dramatically affect the transport properties of the anions showing a VTF rather than an Arrhenius behavior with temperature