title: Cost-effectiveness of strategies to increase screening coverage for cervical cancer in Spain: the CRIVERVA study.
abstract: The aim of the study is to carry out a cost-effectiveness analysis of three different interventions to promote the uptake of screening for cervical cancer in general practice in the county of Valles Occidental, Barcelona, Spain.
  
  
  
  Women aged from 30 to 70 years (n = 15,965) were asked to attend a general practice to be screened. They were randomly allocated to one of four groups: no intervention group (NIG); one group where women received an invitation letter to participate in the screening (IG1); one group where women received an invitation letter and informative leaflet (IG2); and one group where women received an invitation letter, an informative leaflet and a phone call reminder (IG3). Clinical effectiveness was measured as the percentage increase in screening coverage. A cost-effectiveness analysis was performed from the perspective of the public health system with a time horizon of three to five years - the duration of the randomised controlled clinical trial. In addition, a deterministic sensitivity analysis was performed. Results are presented according to different age groups.
  
  
  
  The incremental cost-effectiveness ratio (ICER) for the most cost-effective intervention, IG1, compared with opportunistic screening was € 2.78 per 1% increase in the screening coverage. The age interval with the worst results in terms of efficiency was women aged < 40 years.
  
  
  
  In a population like Catalonia, with around 2 million women aged 30 to 70 years and assuming that 40% of these women were not attending general practice to be screened for cervical cancer, the implementation of an intervention to increase screening coverage which consists of sending a letter would cost on average less than € 490 for every 1000 women.
  
  
  
  ClinicalTrials.gov Identifier: NCT01373723 .
authors.affiliation: Economy and Business Organisation Department, Faculty of Economics and Social Sciences, Universitat Internacional de Catalunya (UIC), Barcelona, Spain. mtrapero@uic.es.|Centre for Research in Economics and Health (CRES), University Pompeu Fabra, c/Immaculada 22, 08017, Barcelona, Spain. mtrapero@uic.es.
authors.forename: Marta
authors.initials: M
authors.lastname: Trapero-Bertran
authors.affiliation: Atenció a la Salut Sexual i Reproductiva (ASSIR) SAP Cerdanyola-Ripollet, Institut Catala de la Salut, Ripollet, Barcelona, Spain.|Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol. Sabadell, Barcelona, Spain.|Grup de Recerca GRASSIR reconegut per la Generalitat de Catalunya SGR 2014-2016, Barcelona, Spain.|Universitat de Barcelona, Barcelona, Spain.
authors.forename: Amelia
authors.initials: A
authors.lastname: Acera Pérez
authors.affiliation: ​Cancer Epidemiology Research Programme (CERP), ​​​Institut Català d'Oncologia-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.|Centro de Investigación Biomédica en Red (CIBERESP), Barcelona, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: de Sanjosé
authors.affiliation: Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol. Sabadell, Barcelona, Spain.|Departament de Infermeria, Universitat Autonoma de Barcelona, Bellaterra, Barcelona, Spain.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Manresa Domínguez
authors.affiliation: Atenció a la Salut Sexual i Reproductiva (ASSIR) SAP Cerdanyola-Ripollet, Institut Catala de la Salut, Ripollet, Barcelona, Spain.
authors.forename: Diego
authors.initials: D
authors.lastname: Rodríguez Capriles
authors.affiliation: Atenció a la Salut Sexual i Reproductiva (ASSIR) SAP Cerdanyola-Ripollet, Institut Catala de la Salut, Ripollet, Barcelona, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Rodriguez Martinez
authors.affiliation: SAP Vallés Occidental, Institut Català de la Salut, Sabadell, Barcelona, Spain.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Bonet Simó
authors.affiliation: Sistemes d'Informació Sanitària, SAP Vallés Occidental, Institut Catala de la Salut, Sabadell, Barcelona, Spain.
authors.forename: Norman
authors.initials: N
authors.lastname: Sanchez Sanchez
authors.affiliation: SAP Vallés Occidental, Institut Català de la Salut, Sabadell, Barcelona, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Hidalgo Valls
authors.affiliation: ​Cancer Epidemiology Research Programme (CERP), ​​​Institut Català d'Oncologia-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.|Centro de Investigación Biomédica en Red (CIBERESP), Barcelona, Spain.
authors.forename: Mireia
authors.initials: M
authors.lastname: Díaz Sanchis
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D013030:Spain; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control*; D014932:Women's Health Services / Q000191:economics / Q000458:organization & administration
keywords: Cervical cancer; Cost-effectiveness; Increase coverage; Population screening