Cost-effectiveness of a stepwise intervention to promote adherence to cervical cancer screening

Abstract Background Cervical cancer screening is effective in reducing mortality, but adherence is generally low. We aimed to investigate the cost-effectiveness of a stepwise intervention to promote adherence to cervical cancer screening in Portugal. Methods We developed a decision tree model to compare the cost-effectiveness of four competing interventions to increase adherence to cervical cancer screening: (i) a written letter (standard-of-care); (ii) automated short message service text messages (SMS)/phone calls/reminders; (iii) automated SMS/phone calls/reminders + manual phone calls; (iv) automated SMS/phone calls/reminders + manual phone calls + face-to-face interviews. The main outcome measure was cost per quality-adjusted life year (QALY) measured over a 5-year time horizon. Costs were calculated from the societal and provider perspectives. Results From the societal perspective, the optimal strategy was automated SMS/phone calls/reminders, below a threshold of €8171 per QALY; above this and below €180 878 per QALY, the most cost-effective strategy was automated SMS/phone calls/reminders + manual phone calls and above this value automated SMS/phone calls/reminders + manual phone calls + face-to-face interviews. From the provider perspective, the ranking of the three strategies in terms of cost-effectiveness was the same, for thresholds of €2756 and €175 463 per QALY, respectively. Conclusions Assuming a willingness-to-pay threshold of one time the national gross domestic product (€22 398/QALY), automated SMS/phone calls/reminders + manual phone calls is a cost-effective strategy to promote adherence to cervical cancer screening, both from the societal and provider perspectives.

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Cost-effectiveness of primarily human papillomavirus–based cervical cancer screening in settings with currently established Pap screening: A systematic review commissioned by the German Federal Ministry of Health

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462308080264 ◽

2008 ◽

Vol 24 (02) ◽

pp. 184-192 ◽

Cited By ~ 13

Author(s):

Nikolai Mühlberger ◽

Gaby Sroczynski ◽

Eva Esteban ◽

Thomas Mittendorf ◽

Rebecca A. Miksad ◽

...

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Cost Effectiveness ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Cost Effective ◽

Pap Screening ◽

Screening Strategies ◽

Hpv Screening ◽

The Cost

Objectives:The aim of this study was to summarize the current evidence for the cost-effectiveness of primarily human papillomavirus (HPV) -based cervical cancer screening in settings with already established Papanicolaou test (Pap) programs. Emphasis was placed on the German situation with annual Pap screening.Methods:Medical, economic, and health technology assessment (HTA) databases were systematically searched for cost-effectiveness studies comparing HPV to Pap screening. Study data were extracted, standardized, and summarized in cost-effectiveness plots contrasting HPV strategies to Pap screening with 1-, 2-, 3-, and 5-years interval. For each Pap setting, the likelihood of cost-effective HPV screening was assessed depending on willingness-to-pay.Results:We reviewed twelve decision-analytic cost-effectiveness models. Study results showed wide variation due to methodical heterogeneity. Data synthesis revealed that the cost-effectiveness of HPV screening depends on the interval of the established Pap screening strategy. In comparison with Pap screening every 2 years, only 25 percent of the HPV-based screening strategies were cost-effective. However, in comparison with Pap screening every 1, 3, or 5 years, 83 percent, 55 percent, and 92 percent of HPV screening strategies were cost-effective, respectively. Results for settings with annual Pap screening are based on models assuming 100 percent screening coverage.Conclusions:The introduction of HPV-based screening programs is cost-effective if the screening interval of the established Pap program exceeds 2 years. In settings with biennial Pap screening, introduction of HPV-based screening is unlikely to be cost-effective. Results also suggest cost-effectiveness of HPV-based screening in settings with annual Pap screening; however, this finding should be confirmed under realistic screening adherence assumptions.

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Impact of Patient Adherence and Test Performance on the Cost-Effectiveness of Cervical Cancer Screening in Developing Countries

Women s Health Issues ◽

10.1016/j.whi.2009.09.001 ◽

2010 ◽

Vol 20 (1) ◽

pp. 35-42 ◽

Cited By ~ 16

Author(s):

Rebecca B. Perkins ◽

Sarah M. Langrish ◽

Linda J. Stern ◽

James F. Burgess ◽

Carol J. Simon

Keyword(s):

Cervical Cancer ◽

Developing Countries ◽

Cost Effectiveness ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Test Performance ◽

Patient Adherence ◽

The Cost

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Revisiting the Cost-Effectiveness of HPV Co-Testing Versus Primary HPV Testing for Cervical Cancer Screening

Journal of Women's Health and Development ◽

10.26502/fjwhd.2644-28840069 ◽

2021 ◽

Vol 04 (04) ◽

Author(s):

Jeffrey D Miller ◽

Adrian Vilalta ◽

Kathleen A Troeger

Keyword(s):

Cervical Cancer ◽

Cost Effectiveness ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Hpv Testing ◽

The Cost

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Cervical cancer screening by direct visual inspection was the most cost-effective strategy for developing countries

Evidence-based Obstetrics and Gynaecology ◽

10.1054/ebog.2002.0016 ◽

2002 ◽

Vol 4 (1) ◽

pp. 44-45

Author(s):

Henry C. Kitchener

Keyword(s):

Cervical Cancer ◽

Developing Countries ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Visual Inspection ◽

Cost Effective ◽

Effective Strategy ◽

Cost Effective Strategy

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PP62 Cost-Effectiveness Of Cervical Cancer Screening In Estonia

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462319002137 ◽

2019 ◽

Vol 35 (S1) ◽

pp. 49-49

Author(s):

Triin Võrno ◽

Kaja-Triin Laisaar ◽

Terje Raud ◽

Kai Jõers ◽

Doris Meigas-Tohver ◽

...

Keyword(s):

Cervical Cancer ◽

Cost Effectiveness ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Screening Program ◽

Pap Test ◽

Cancer Screening Program ◽

Hpv Test ◽

Cervical Cancer Screening Program ◽

The Cost

IntroductionIn Estonia, organized cervical cancer screening program is targeted at women aged 30–55(59) years and Pap-tests are taken every five years. Since cervical cancer is associated with human papillomavirus (HPV), a number of countries have introduced the HPV-test as the primary method of screening. The objective of this study was to evaluate the cost-effectiveness of organized cervical cancer screening program in Estonia by comparing HPV- and Pap-test based strategies.MethodsFor the cost-effectiveness analysis, a Markov cohort model was developed. The model was used to estimate costs and quality-adjusted life-years (QALYs) of eight screening strategies, varying the primary screening test and triage scenarios, upper age limit of screening, and testing interval. Incremental cost-effectiveness ratios (ICERs) were calculated in comparison to current screening practice as well as to the next best option. Sensitivity analysis was performed by varying one or more similar parameter(s) at a time, while holding others at their base case value. The analysis was performed from the healthcare payer perspective adopting a five percent annual discount rate for both costs and utilities.ResultsIn the base-case scenario, ICER for HPV-test based strategies in comparison to the current screening practice was estimated at EUR 8,596–9,786 per QALY. For alternative Pap-test based strategies ICER was estimated at EUR 2,332–2,425 per QALY. In comparison to the next best option, HPV-test based strategies were dominated by Pap-test based strategies. At the cost-effectiveness threshold of EUR 10,000 per QALY Pap-testing every three years would be the cost-effective strategy for women participating in the screening program from age 30 to 63 (ICER being EUR 3,112 per QALY).ConclusionsDecreasing Pap-test based screening interval or changing to HPV-test based screening can both improve the effectiveness of cervical cancer screening program in Estonia, but based on the current cost-effectiveness study Pap-test based screening every three years should be preferred.

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Stepwise strategy to improve Cervical Cancer Screening Adherence (SCAN-CC): automated text messages, phone calls and face-to-face interviews: protocol of a population-based randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2017-017730 ◽

2017 ◽

Vol 7 (10) ◽

pp. e017730 ◽

Cited By ~ 5

Author(s):

João Firmino-Machado ◽

Romeu Mendes ◽

Amélia Moreira ◽

Nuno Lunet

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Controlled Trial ◽

Population Based ◽

Text Messages ◽

Phone Call ◽

Face To Face ◽

Phone Calls ◽

And Control

IntroductionScreening is highly effective for cervical cancer prevention and control. Population-based screening programmes are widely implemented in high-income countries, although adherence is often low. In Portugal, just over half of the women adhere to cervical cancer screening, contributing for greater mortality rates than in other European countries. The most effective adherence raising strategies are based on patient reminders, small/mass media and face-to-face educational programmes, but sequential interventions targeting the general population have seldom been evaluated. The aim of this study is to assess the effectiveness of a stepwise approach, with increasing complexity and cost, to improve adherence to organised cervical cancer screening: step 1a—customised text message invitation; step 1b—customised automated phone call invitation; step 2—secretary phone call; step 3—family health professional phone call and face-to-face appointment.MethodsA population-based randomised controlled trial will be implemented in Portuguese urban and rural areas. Women eligible for cervical cancer screening will be randomised (1:1) to intervention and control. In the intervention group, women will be invited for screening through text messages, automated phone calls, manual phone calls and health professional appointments, to be applied sequentially to participants remaining non-adherent after each step. Control will be the standard of care (written letter). The primary outcome is the proportion of women adherent to screening after step 1 or sequences of steps from 1 to 3. The secondary outcomes are: proportion of women screened after each step (1a, 2 and 3); proportion of text messages/phone calls delivered; proportion of women previously screened in a private health institution who change to organised screening. The intervention and control groups will be compared based on intention-to-treat and per-protocol analyses.Ethics and disseminationThe study was approved by the Ethics Committee of the Northern Health Region Administration and National Data Protection Committee. Results will be disseminated through communications in scientific meetings and peer-reviewed journals.Trial numberNCT03122275

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