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

• Published in: International journal of environmental research and public health 2019-12, Vol.16 (24), p.5035
• Main Authors: Paulauskiene, Justina, Stelemekas, Mindaugas, Ivanauskiene, Rugile, Petkeviciene, Janina
• Format: Article
• Language: English
• Subjects: Adult; Cervical cancer; Cervix; Clinical trials; Correspondence as Topic; Cost analysis; Cost-Benefit Analysis; Costs; Early Detection of Cancer - economics; Early Detection of Cancer - methods; Family Practice - economics; Family Practice - methods; Female; Health; Health Care Costs - statistics & numerical data; Health insurance; Health sciences; Hospitals; Humans; Insurance; Lithuania; Medical screening; Methods; Middle Aged; Mortality; Papanicolaou Test; Participation; Patient Acceptance of Health Care - statistics & numerical data; Physician-Patient Relations; Quality control; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - economics; Uterine Cervical Neoplasms - psychology; Vaginal Smears - economics; Womens health
• ISSN: 1660-4601; 1661-7827; 1660-4601
• DOI: 10.3390/ijerph16245035

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.