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

Acera, Amelia; Rodriguez, Ana; Trapero-Bertran, Marta; Soteras, Pilar; Sànchez, Norman; Bonet, Josep Maria Martí i; Manresa, Josep María; Hidalgo, Pablo; Prieto, Gemma

doi:10.1186/1472-6963-11-278

Cited by 8 publications

(12 citation statements)

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“…A recent evaluation of this strategy [ 29 ] showed that underscreened women had a high burden of cervical disease. Attempts to extend these initiatives into an organized activity are undergoing [ 30 ] a randomized trial inviting these women to participate in the screening program.…”

Section: Discussionmentioning

confidence: 99%

Underscreened Women Remain Overrepresented in the Pool of Cervical Cancer Cases in Spain: A Need to Rethink the Screening Interventions

Ibáñéz

Alejo

Combalía

et al. 2015

BioMed Research International

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Objective. Audit of women with invasive cervical cancer (CC) is critical for quality control within screening activities. We analysed the screening history in the 10 years preceding the study entry in women with and without CC during 2000–2011. Methods. 323 women with CC from six pathology departments in Catalonia (Spain) and 23,782 women with negative cytology were compared. Age, previous history of cytologies, and histological type and FIGO stage were collected from the pathology registries. Logistic regression analysis was used to estimate odds ratios (OR) and 95% confidence intervals (CI95%). Results. History of cytology was registered in 26.2% of CC cases and in 78% of the control women (P < 0.0001) and its frequency decreased with increasing age. Compared to women with squamous cell carcinoma, adenocarcinoma cases were significantly more likely to have a cytology within the 3-year interval preceding cancer diagnosis (OR = 2.6 CI 95%: 1.2–5.6) and to have normal cytology results in previous screenings (OR = 2.4 CI 95%: 1.2–4.5). FIGO II–IV cases were more common among older women (older than 60 years). Conclusions. Absence of prior screening history was extremely common among CC cases compared to controls. Organized actions to reduce underscreened women and use of highly sensitive HPV-based tests could be important to reduce CC burden.

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Section: Discussionmentioning

confidence: 99%

Underscreened Women Remain Overrepresented in the Pool of Cervical Cancer Cases in Spain: A Need to Rethink the Screening Interventions

Ibáñéz

Alejo

Combalía

et al. 2015

BioMed Research International

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“…This baseline higher screening coverage among the youngest is likely to be explained by the higher contact with reproductive health care centers and implying that women are more likely to be offered a screening test together with other medical services related to contraception or reproduction. Although our control arm showed poorer screening uptake compared to the IGs (84.1%) the final coverage was higher (64.8%) than the average reported for Catalonia [16]. This can be explained by the fact that the four areas included in the study from SAP Cerdanyola have traditionally shown to have a good connection with the NHS.…”

Section: Discussionmentioning

confidence: 58%

“…This can be explained by the fact that the four areas included in the study from SAP Cerdanyola have traditionally shown to have a good connection with the NHS. These areas are represent a metropolitan urban environment with high predominance of working class, where half of the women have a primary school completed or less and show an almost universal use of the Public Health Services compared to other areas in Catalonia [16]. …”

Section: Discussionmentioning

confidence: 99%

“…The CRICERVA study [15, 16] is a cluster randomised community-based clinical trial implemented within the Cerdanyola Primary Health Care Service (SAP Cerdanyola). SAP Cerdanyola is a predefined geographical area located in the metropolitan belt of Barcelona, Spain ( S1 File Published protocol S2 File .- Study protocol Spanish, S3 File .- Study protocol English translation, S4 File .- Consort Checklist).…”

Section: Methodsmentioning

confidence: 99%

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Increasing Cervical Cancer Screening Coverage: A Randomised, Community-Based Clinical Trial

et al. 2017

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BackgroundOpportunistic cervical cancer screening can lead to suboptimal screening coverage. Coverage could be increased after a personalised invitation to the target population. We present a community randomized intervention study with three strategies aiming to increase screening coverage.MethodsThe CRICERVA study is a community-based clinical trial to improve coverage of population-based screening in the Cerdanyola SAP area in Barcelona.A total of 32,858 women residing in the study area, aged 30 to 70 years were evaluated. A total of 15,965 women were identified as having no registration of a cervical cytology in the last 3.5 years within the Public Health data base system. Eligible women were assigned to one of four community randomized intervention groups (IGs): (1) (IG1 N = 4197) personalised invitation letter, (2) (IG2 N = 3601) personalised invitation letter + informative leaflet, (3) (IG3 N = 6088) personalised invitation letter + informative leaflet + personalised phone call and (4) (Control N = 2079) based on spontaneous demand of cervical cancer screening as officially recommended. To evaluate screening coverage, we used heterogeneity tests to compare impact of the interventions and mixed logistic regression models to assess the age effect. We refer a “rescue” visit as the screening visit resulting from the study invitation.ResultsAmong the 13,886 women in the IGs, 2,862 were evaluated as having an adequate screening history after the initial contact; 4,263 were lost to follow-up and 5,341 were identified as having insufficient screening and thus being eligible for a rescue visit. All intervention strategies significantly increased participation to screening compared to the control group. Coverage after the intervention reached 84.1% while the control group reached 64.8%. The final impact of our study was an increase of 20% in the three IGs and of 9% in the control group (p<0.001). Within the intervention arms, age was an important determinant of rescue visits showing a statistical interaction with the coverage attained in the IGs. Within the intervention groups, final screening coverage was significantly higher in IG3 (84.4%) (p<0.001). However, the differences were more substantial in the age groups 50–59 and those 60+. The highest impact of the IG3 intervention was observed among women 60+ y.o with 32.0% of them being rescued for screening. The lowest impact of the interventions was in younger women.ConclusionsThe study confirms that using individual contact methods and assigning a fixed screening date notably increases participation in screening. The response to the invitation is strongly dependent on age.Trial RegistrationClinicalTrials.gov NCT01373723

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“…The aim of this study is to perform a cost-effectiveness analysis alongside the CRICERVA clinical trial, (Acera et al: Increasing cervical cancer screening coverage: a randomised, community-based clinical trial, accepted and forthcoming) of three different active interventions to promote the uptake of screening for cervical cancer in general practice. An orientative protocol of this economic evaluation was first published in 2011 [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of strategies to increase screening coverage for cervical cancer in Spain: the CRIVERVA study

et al. 2017

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BackgroundThe 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.MethodsWomen 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.ResultsThe 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.ConclusionsIn 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.Trial registrationClinicalTrials.gov Identifier: NCT01373723.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4115-0) contains supplementary material, which is available to authorized users.

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

Cited by 8 publications

References 25 publications

Underscreened Women Remain Overrepresented in the Pool of Cervical Cancer Cases in Spain: A Need to Rethink the Screening Interventions

Underscreened Women Remain Overrepresented in the Pool of Cervical Cancer Cases in Spain: A Need to Rethink the Screening Interventions

Increasing Cervical Cancer Screening Coverage: A Randomised, Community-Based Clinical Trial

Cost-effectiveness of strategies to increase screening coverage for cervical cancer in Spain: the CRIVERVA study

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