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

BMC Public Health. 2017 Feb 14;17(1):194. doi: 10.1186/s12889-017-4115-0.


Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Trial registration: Identifier: NCT01373723 .

Keywords: Cervical cancer; Cost-effectiveness; Increase coverage; Population screening.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Cost-Benefit Analysis
  • Female
  • Humans
  • Mass Screening / economics*
  • Middle Aged
  • Patient Acceptance of Health Care*
  • Spain
  • Uterine Cervical Neoplasms / diagnosis
  • Uterine Cervical Neoplasms / economics
  • Uterine Cervical Neoplasms / prevention & control*
  • Women's Health Services / economics
  • Women's Health Services / organization & administration

Associated data