Cost-effectiveness of strategies to increase screening coverage for cervical cancer in Spain: the CRIVERVA study

Marta Trapero-Bertran, Amelia Acera Pérez, Silvia De Sanjosé, Josep Maria Manresa Domínguez, Diego Rodríguez Capriles, Ana Rodriguez Martinez, Josep Maria Bonet Simó, Norman Sanchez Sanchez, Pablo Hidalgo Valls, Mireia Díaz Sanchis

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    Abstract

    © 2017 The Author(s). Background: The aim of the study is to carry out a cost-effectiveness analysis of three different interventions to promote the uptake of screening for cervical cancer in general practice in the county of Valles Occidental, Barcelona, Spain. Methods: Women aged from 30 to 70 years (n = 15,965) were asked to attend a general practice to be screened. They were randomly allocated to one of four groups: no intervention group (NIG); one group where women received an invitation letter to participate in the screening (IG1); one group where women received an invitation letter and informative leaflet (IG2); and one group where women received an invitation letter, an informative leaflet and a phone call reminder (IG3). Clinical effectiveness was measured as the percentage increase in screening coverage. A cost-effectiveness analysis was performed from the perspective of the public health system with a time horizon of three to five years - the duration of the randomised controlled clinical trial. In addition, a deterministic sensitivity analysis was performed. Results are presented according to different age groups. Results: The incremental cost-effectiveness ratio (ICER) for the most cost-effective intervention, IG1, compared with opportunistic screening was € 2.78 per 1% increase in the screening coverage. The age interval with the worst results in terms of efficiency was women aged < 40 years. Conclusions: In a population like Catalonia, with around 2 million women aged 30 to 70 years and assuming that 40% of these women were not attending general practice to be screened for cervical cancer, the implementation of an intervention to increase screening coverage which consists of sending a letter would cost on average less than € 490 for every 1000 women. Trial registration: ClinicalTrials.gov Identifier: NCT01373723 .
    Original languageEnglish
    Article number194
    JournalBMC Public Health
    Volume17
    Issue number1
    DOIs
    Publication statusPublished - 14 Feb 2017

    Keywords

    • Cervical cancer
    • Cost-effectiveness
    • Increase coverage
    • Population screening

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