title: United Kingdom cervical cancer screening and the costs of time and travel.
abstract: OBJECTIVE
  The aim of this study was to estimate the time and travel costs generated by women when attending for Papanicolaou (Pap) smear tests or colposcopy appointments in the United Kingdom, both absolutely and relative to the health service cost of the national cervical cancer screening programs.
  
  
  METHODS
  Data were obtained from questionnaires completed by two samples of women participating in a three-center trial of management of low-grade abnormalities detected by screening (n = 1,106 for Pap smears and n = 1,203 for colposcopy appointments). Women were 20 to 59 years of age and resident in Grampian or Tayside, Scotland, or Nottingham, England. Questionnaire data were supplemented with sociodemographic information previously collected at the time of recruitment to the trial.
  
  
  RESULTS
  The mean total time and travel costs per attendance at a smear test and at a colposcopy appointment were estimated to be 9.2 pounds and 27.4 pounds, respectively, averaged across the three trial areas (valued at 2002 prices). Statistically significant intercenter disparities in time and travel costs were identified, particularly with respect to colposcopy appointments. For these, time and travel costs in Nottingham were substantially less than those in Grampian and Tayside (22.9 pounds, 30.2 pounds, and 32.1 pounds, respectively). Time and travel costs amount to 26 and 33 percent, approximately, over and above the direct health service costs of the English and Scottish screening programs, respectively.
  
  
  CONCLUSIONS
  The time and travel costs associated with participation in the UK cervical cancer screening programs are substantial and are not spatially uniform across the country.
authors.affiliation: University of Nottingham, UK. Claire.wooley@nottingham.ac.uk
authors.forename: Claire
authors.initials: C
authors.lastname: Woolley
authors.forename: Zoë
authors.initials: Z
authors.lastname: Philips
authors.forename: David K
authors.initials: DK
authors.lastname: Whynes
authors.forename: Seonaidh C
authors.initials: SC
authors.lastname: Cotton
authors.forename: Nicola M
authors.initials: NM
authors.lastname: Gray
authors.forename: Linda
authors.initials: L
authors.lastname: Sharp
authors.forename: Julian
authors.initials: J
authors.lastname: Little
authors.forename: Norman R
authors.initials: NR
authors.lastname: Waugh
mesh_terms: D000328:Adult; D003127:Colposcopy; D004739:England; D005260:Female; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test; D012606:Scotland; D013222:State Medicine; D011795:Surveys and Questionnaires; D013997:Time Factors; D014195:Travel / Q000191:economics*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears