The Cost-Effectiveness Analysis of Cervical Cancer Screening Using a Systematic Invitation System in Lithuania
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Collection and Study Design
2.2. Invitation Strategies and Costs
2.3. The Cost of Healthcare Services
2.4. Economic Analysis
3. Results
3.1. The Participation in CC Screening and Pap Smear Test Results
3.2. The Cost-Effectiveness Analysis
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Cost Category | Description | Unit Cost (€) |
---|---|---|
A verbal invitation from a family doctor | Reimbursed cost of the invitation | 1.45 |
Cost of time spent for a verbal invitation by a family doctor (calculated using an average of hourly wage rate). | 0.70 | |
A personal invitation letter | Reimbursed cost of the invitation | 1.45 |
Cost of time of the screening department staff for identification of unscreened women, preparation and sending out of invitation letters (calculated using hourly wage rate). | 0.30 | |
A personal reminder letter | Cost of a personal invitation letter discounted by 5%. | 1.67 |
Pap smear test-taking | Reimbursed cost | 3.79 |
Conventional Pap smear test assessment | Reimbursed cost | 5.79 |
Information about the Pap smear test result | Cost of time spent (calculated using hourly wage rate): | |
a family doctor | 2.80 | |
screening department staff | 0.08 | |
a nurse | 1.28 |
Pap Smear Test Results | Experimental Group | Control Group | |
---|---|---|---|
The First Invitation Letter (n = 391) | The Reminder Letter (n = 176) | Invitation by a Family Doctor (n = 211) | |
n (%) | n (%) | n (%) | |
Unknown a | 8 (2.0) | 1 (0.6) | 3 (1.4) |
Inadequate b | 12 (3.1) | 3 (1.7) | 5 (2.4) |
Normal | 270 (69.1) | 133 (75.6) | 153 (72.5) |
Abnormal c | 101 (25.8) | 39 (22.2) | 50 (23.7) |
ASC-US | 42 (10.7) | 14 (7.9) | 17 (8.1) |
ASC-H | - | 1 (0.6) | 1 (0.5) |
LSIL | 59 (15.1) | 24 (13.6) | 30 (14.2) |
HSIL | - | - | 2 (0.9) |
Cost Category | Unit Cost (€) | Invitation Strategy 1 (n = 1703) | Invitation Strategy 2 (n = 1591) | Invitation Strategy 3 (n = 1591) | |||
---|---|---|---|---|---|---|---|
n | Cost (€) | n | Cost (€) | n | Cost (€) | ||
A verbal invitation from a family doctor | 2.15 | 817 | 1756.55 | ||||
A personal invitation letter | 1.75 | 1591 | 2784.25 | 1591 | 2784.25 | ||
A personal reminder letter | 1.67 | 1042 | 1740.14 | ||||
Pap smear test-taking | 3.79 | 211 | 799.69 | 391 | 1481.89 | 567 | 2117.25 |
Conventional Pap smear test assessment | 5.79 | 204 | 1181.16 | 383 | 2217.57 | 558 | 3181.82 |
Information about the Pap smear test result: | |||||||
family doctor | 2.80 | 70 | 196 | ||||
screening department staff | 0.08 | 290 | 23.2 | 427 | 34.16 | ||
nurse | 1.28 | 101 | 129.28 | 140 | 176.86 | ||
Cost of screened women: invitation + performed Pap smear test | 2556.24 | 4266.14 | 6641.64 | ||||
Total cost | 3933.40 | 6636.19 | 10034.48 | ||||
Expected cost per one screened woman | 1.51 | 2.68 | 4.17 | ||||
Expected cost per one abnormal Pap smear test detected | 2.29 | 4.18 | 6.31 | ||||
Probability of a woman being screened * | 0.124 | 0.246 | 0.357 | ||||
Probability of abnormal Pap smear test detected * | 0.029 | 0.063 | 0.088 | ||||
ICER per one additionally screened woman | 9.67 | 13.47 | |||||
ICER per one additional abnormal Pap smear test detected | 55.21 | 86.88 |
Scenario | Invitation Strategy | ICER (1) | ICER (2) |
---|---|---|---|
Base case | Strategy 2 (invitation letter) versus strategy 1 (regular practice) | €9.67 | €55.21 |
Strategy 3 (invitation letter + reminder letter) versus strategy 2 (invitation letter) | €13.47 | €86.88 | |
Without the discounting of a reminder letter | Strategy 2 (invitation letter) versus strategy 1 (regular practice) | €9.67 | €55.21 |
Strategy 3 (invitation letter + reminder letter) versus strategy 2 (invitation letter) | €14.15 | €91.23 | |
Without salary expenses | Strategy 2 (invitation letter) versus strategy 1 (regular practice) | €9.96 | €55.86 |
Strategy 3 (invitation letter + reminder letter) versus strategy 2 (invitation letter) | €11.78 | €77.78 | |
Expenses of invitation services decrease by 20% | Strategy 2 (invitation letter) versus strategy 1 (regular practice) | €8.43 | €50.79 |
Strategy 3 (invitation letter + reminder letter) versus strategy 2 (invitation letter) | €11.89 | €79.62 | |
Expenses of invitation services increase by 20% | Strategy 2 (invitation letter) versus strategy 1 (regular practice) | €10.90 | €59.63 |
Strategy 3 (invitation letter + reminder letter) versus strategy 2 (invitation letter) | €15.12 | €94.33 |
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Paulauskiene, J.; Stelemekas, M.; Ivanauskiene, R.; Petkeviciene, J. The Cost-Effectiveness Analysis of Cervical Cancer Screening Using a Systematic Invitation System in Lithuania. Int. J. Environ. Res. Public Health 2019, 16, 5035. https://doi.org/10.3390/ijerph16245035
Paulauskiene J, Stelemekas M, Ivanauskiene R, Petkeviciene J. The Cost-Effectiveness Analysis of Cervical Cancer Screening Using a Systematic Invitation System in Lithuania. International Journal of Environmental Research and Public Health. 2019; 16(24):5035. https://doi.org/10.3390/ijerph16245035
Chicago/Turabian StylePaulauskiene, Justina, Mindaugas Stelemekas, Rugile Ivanauskiene, and Janina Petkeviciene. 2019. "The Cost-Effectiveness Analysis of Cervical Cancer Screening Using a Systematic Invitation System in Lithuania" International Journal of Environmental Research and Public Health 16, no. 24: 5035. https://doi.org/10.3390/ijerph16245035