Economic evaluation of three populational screening strategies for cervical cancer in the county of Valles Occidental: CRICERVA clinical trial.
BACKGROUND
A 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
A 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.


CONCLUSIONS
IG3 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.


BACKGROUND
Clinical Trials.gov Identifier NCT01373723.
Atenció a la Salut Sexual i Reproductiva SAP Cerdanyola -Ripollet, Institut Catala de la Salut, Barcelona, Spain. amelia.acera@gmail.com
Amelia
A
Acera
Ana
A
Rodriguez
Marta
M
Trapero-Bertran
Pilar
P
Soteras
Norman
N
Sanchez
Josep M
JM
Bonet
Josep M
JM
Manresa
Pablo
P
Hidalgo
Pere
P
Toran
Gemma
G
Prieto
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D055088:Early Detection of Cancer / Q000191:economics* / Q000379:methods; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000175:diagnosis; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D013030:Spain; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*