Abstract
BackgroundA high percentage of cervical cancer cases have not undergone cytological tests within 10 years prior to diagnosis. Different population interventions could improve coverage in the public system, although costs will also increase. The aim of this study was to compare the effectiveness and the costs of three types of population interventions to increase the number of female participants in the screening programmes for cancer of the cervix carried out by Primary Care in four basic health care areas.Methods/DesignA cost-effectiveness analysis will be performed from the perspective of public health system including women from 30 to 70 years of age (n = 20,994) with incorrect screening criteria from four basic health care areas in the Valles Occidental, Barcelona, Spain. The patients will be randomly distributed into the control group and the three intervention groups (IG1: invitation letter to participate in the screening; IG2: invitation letter and informative leaflet; IG3: invitation letter, informative leaflet and a phone call reminder) and followed for three years. Clinical effectiveness will be measured by the number of HPV, epithelial lesions and cancer of cervix cases detected. The number of deaths avoided will be secondary measures of effectiveness. The temporal horizon of the analysis will be the life expectancy of the female population in the study. Costs and effectiveness will be discounted at 3%. In addition, univariate and multivariate sensitivity analysis will be carried out.DiscussionIG3 is expected to be more cost-effective intervention than IG1 and IG2, with greater detection of HPV infections, epithelial lesions and cancer than other strategies, albeit at a greater cost.Trial RegistrationClinical Trials.gov Identifier NCT01373723
Highlights
A high percentage of cervical cancer cases have not undergone cytological tests within 10 years prior to diagnosis
Despite being one of the neoplasms with an easy preventive and therapeutic approach, it remains an important cause of morbidmortality, the figures in developed countries are lower than those in developing countries
Due to the high prevalence of cervical cancer cases in this particular county we propose to launch a comparison of three different alternatives to improve the present coverage of the populational screening programmes in all the Basic Health Care Area (BHCA), facilitating accessibility of population to the public health care system
Summary
Cancer of the cervix is the second most frequent cancer in the world among women, with at least 400,000 new cases being detected every year [1]. An increase in screening coverage should be a priority objective for health care authorities if cervical cancer cases are to be reduced and women who do not periodically undergo cytology are to be identified. Systematic screening should be incorporated since these women have a greater risk of having cervical disease because of not having visited the health care system before This would facilitate earlier action in detecting pre-malignant lesions, helpingto t reduce the incidence of invasive cancer. There is: one common action in the three different interventions, which has been scientifically validated as effective, consisting in a personalized invitation letter sent by the primary health care professionals including a fixed appointment to undergo through a cytology test and, other two different interventions (informative leaflet and reminder call) to evaluate approaches for which there are few studies assessing the effectiveness of attendance to screening programmes. Statistical analysis Preparation and diffusion of results Preparation of the final report CEIC: Clinical Research Ethical Committees; QRD: Online workbook data collection
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