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, 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

Abstract

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 .

Keywords: Cervical cancer; Cost-effectiveness; Increase coverage; Population screening.

References

    1. de Sanjosé Llongueras S and García García AM. Virus del Papiloma Humano y Cáncer: Epidemiología y Prevención. 4ª Monografía de la Sociedad Española de Epidemiología. 2006. ISBN: 690-0811-0.
    1. Allemani C, Weir HK, Carreira H, Harewood R, Spika D, Wang X-S, et al. Global surveillance of cancer survival 1995-2009: analysis of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2) Lancet. 2015;385(9972):977–1010. doi: 10.1016/S0140-6736(14)62038-9.
    1. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. Cancer incidence and mortality worldwide: IARC CancerBase No. 11. Lyon, France: International Agency for Research on Cancer. GLOBOCAN 2012 v1.0. . Accessed on January 2016].
    1. Clèries R, Esteban L, Borràs J, Marcos-Gragera R, Freitas A, Carulla M, et al. Time trends of cancer incidence and mortality in Catalonia during 1993–2007. Clin Transl Oncol. 2014;16(1):18–28. doi: 10.1007/s12094-013-1060-y.
    1. Luengo-Fernández R, Leal J, Gray A, Sullivan R. Economic burden of cancer across the European Union: a population-based cost analysis. Lancet. 2013;14(12):1165–74. doi: 10.1016/S1470-2045(13)70442-X.
    1. Lew J-B, Howard K, Gertig D, Smith M, Clements M, Nickson C, et al. Expenditure and resource utilisation for cervical screening in Australia. BMC Health Serv Res. 2012;12:446. doi: 10.1186/1472-6963-12-446.
    1. Anttila A, Ronco G. Description of the national situation of cervical cancer screening in the member states of the European Union. Eur J Cancer. 2009;45:2685–708. doi: 10.1016/j.ejca.2009.07.017.
    1. European CDC (ECDC) Guidance for the introduction of hpv vaccines in European Union countries. Stockholm: European Centre for Disease Prevention and Control; 2008.
    1. Everett T, Bryant A, Griffin MF, Martin-Hirsch PPL, Forbes CA, Jepson RG. Interventions targeted at women to encourage the uptake of cervical screening. Cochrane Database Syst Rev. 2011;5:CD002834.
    1. Sabatino SA, Lawrence B, Elder R, Mercer SL, Wilson KM, DeVinney B, et al. Effectiveness of interventions to increase screening for breast, cervical, and colorectal cancers: nine updated systematic reviews for the guide to community preventive services. Am J Prev Med. 2012;43:97–118. doi: 10.1016/j.amepre.2012.04.009.
    1. Dinkelspiel H, Fetterman B, Poitras N, Kinney W, Cox JT, Lorey T, et al. Screening history preceding a diagnosis of cervical cancer in women age 65 and older. Gynecol Oncol. 2012;126:203–6. doi: 10.1016/j.ygyno.2012.04.037.
    1. Acera A, Rodriguez A, Trapero-Bertran M, Soteras P, Sanchez N, Bonet JM, et al. Economic evaluation of three populational screening strategies for cervical cancer in the county of Valles Occidental: CRICERVA clinical trial. BMC Health Serv Res. 2011;11:278. doi: 10.1186/1472-6963-11-278.
    1. Georgalis L, de Sanjosé S, Esnaola M, Bosch FX, Diaz M. Present and future of cervical cancer prevention in Spain: a cost-effectiveness analysis. Eur J Cancer Prev. 2015. Epub ahead of print.
    1. Atenció a la Salut Sexual i Reproductiva Cerdanyola: Productes Intermedis. Area Metropolitana Nord. Institut Català de la Salut. Generalitat de Catalunya; 2014.
    1. Instituto Nacional de Estadística: Actualización de rentas con el IPC general (sistema IPC base 2011) para periodos anuales completos. INE; 2015. . [Accessed on January 2016].
    1. Gray AM, Clarke PM, Wolstenholme JL, Wordsworth S. Applied methods of cost-effectiveness analysis in health care. Oxford: Oxford University Press; 2011.
    1. Hyndman JC, Straton JA, Pritchard DA, Le Sueur H. Cost-effectiveness of interventions to promote cervical screening in general practice. Aust New Zeland J Public Health. 1996;20(3):272–7. doi: 10.1111/j.1467-842X.1996.tb01028.x.
    1. Broberg G, Miao Jonasson J, Ellis J, Gyrd-Hansen D, Anjemark B, Glantz A, et al. Increasing participation in cervical cancer screening: telephone contact with long-term non-attendees in Sweden. Results from RACOMIP, a randomized controlled trial. Int J Cancer. 2013;133(1):164–71. doi: 10.1002/ijc.27985.
    1. Heranney D, Fender M, Velten M, Baldauf JJ. A prospective randomized study of two reminding strategies: telephone versus mail in the screening of cervical cancer in women who did not initially respond. Acta Cytol. 2011;55(4):334–40. doi: 10.1159/000327527.
    1. Kesic V, Poljak M, Rogovskaya S. Cervical cancer burden and prevention activities in Europe. Cancer Epidemiol Biomarkers Prev. 2012;21(9):1423–33. doi: 10.1158/1055-9965.EPI-12-0181.
    1. Anttila A, von Karsa L, Aasmaa A, Fender M, Patnick J, Rebolj M, et al. Cervical cancer screening policies and coverage in Europe. Eur J Cancer. 2009;45(15):2649–58. doi: 10.1016/j.ejca.2009.07.020.
    1. Arbyn M, Anttila A, Jordan J, Ronco G, Schenck U, Segnan N, et al. European guidelines for quality assurance in cervical cancer screening. 2. Brussels, Luxemburg: European Community, Office for Official publications of the European Communities; 2008.
    1. Nicula FA, Anttila A, Neamtiu L, Primic Zakelj M, Tachezy R, Chil A, et al. Challenges in starting organised screening programmes for cervical cancer in the new member states of the European Union. Eur J Cancer. 2009;45(15):2679–84. doi: 10.1016/j.ejca.2009.07.025.
    1. Virtanen A, Anttila A, Luostarinen T, Malila N, Nieminen P. Improving cervical cancer screening attendance in Finland. Int J Cancer. 2015;136(6):E667–E684. doi: 10.1002/ijc.29176.
    1. Spadea T, Bellini S, Kunst A, Stirbu I, Costa G. The impact of interventions to improve attendance in female cancer screening among lower socioeconomic groups: a review. Prev Med. 2010;50(4):159–64. doi: 10.1016/j.ypmed.2010.01.007.
    1. De Sanjosé S, Garcia AM. Virus del papiloma humano y cáncer: epidemiología y prevención. Madrid: 4a Monografía de la Sociedad Española de Epidemiologia; 2006. pp. 1–144.
    1. Siebert U, Sroczynski G, Hillemans P, Engel J, Stabenow R, Stegmaier C, et al. The German cervical cancer screening model: development and validation of a decision-analytic model for cervical cancer screening in Germany. Eur J Public Health. 2006;16(2):185–192. doi: 10.1093/eurpub/cki163.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere