The Cost-Effectiveness Analysis of Cervical Cancer Screening Using a Systematic Invitation System in Lithuania.

Justina Paulauskiene,Mindaugas Stelemekas,Janina Petkeviciene,Rugile Ivanauskiene

doi:10.3390/ijerph16245035

Abstract

In Lithuania, cytological screening of cervical cancer (CC) is largely opportunistic. Absence of standardized systematic invitation practice might be the reason for low participation rates. The study aimed to assess the cost-effectiveness of systematic invitation approach in CC screening programme from the perspective of a healthcare provider. A decision tree was used to compare an opportunistic invitation by a family doctor, a personal postal invitation letter with appointment time and place, and a personal postal invitation letter with appointment time and place with one reminder letter. Cost-effectiveness was defined as an incremental cost-effectiveness ratio (ICER) per one additionally screened woman and per one additional abnormal Pap smear test detected. The ICER of one personal postal invitation letter was €9.67 per one additionally screened woman and €55.21 per one additional abnormal Pap smear test detected in comparison with the current screening practice. The ICER of a personal invitation letter with an additional reminder letter compared to one invitation letter was €13.47 and €86.88 respectively. Conclusions: A personal invitation letter approach is more effective in increasing the participation rate in CC screening and the number of detected abnormal Pap smears; however, it incurs additional expenses compared with current invitation practice.

Highlights

Cervical cancer (CC) is the fourth most commonly occurring cancer with fatal outcome in women worldwide [1]
This study aims to analyse the cost-effectiveness of personal invitation letter with appointment time and place, compared to the current practice of opportunistic primary healthcare provider initiative in Lithuania
A systematic personal invitation letter with a reminder letter for non-attendees increased the coverage of CC screening and the proportion of abnormal Pap smear tests detected, but it was more expensive than sending a single personal invitation letter

Summary

Introduction

Cervical cancer (CC) is the fourth most commonly occurring cancer with fatal outcome in women worldwide [1]. In 2018, the estimated age-standardized mortality rates ranged from about 2/100,000 in Western and Northern Europe to more than 19/100,000 in some African countries [1]. CC is the second most common female cancer and the first leading cause of cancer deaths in Lithuanian women aged 15 to 44 years [3]. In 2003, the Council of the EU adopted recommendations on cancer screening, which rely on a population-based organized approach with appropriate quality assurance at all the levels [4,5]. Evidence suggests that a population-based cytological screening programme is an effective method to reduce the incidence and mortality rates of CC [6,7]. CC screening programmes implemented in organized population-based settings ensure greater participation of the target population compared with opportunistic screening, Int. J. Public Health 2019, 16, 5035; doi:10.3390/ijerph16245035 www.mdpi.com/journal/ijerph

Objectives

Methods

Results

Discussion

Conclusion