COST-EFFECTIVENESS OF INTERVENTIONS TO PROMOTE CERVICAL SCREENING IN GENERAL-PRACTICE

A cost-effectiveness study of three different interventions to promote the uptake of screening for cervical cancer in general practice was c arried out in Perth in 1991. Women eligible for a Pap smear were rando mly allocated to one of four soups: one receiving letters with specifi c appointments to attend a screening clinic staffed by female doctors, one receiving letters informing them of the availability of the clini c and suggesting they make an appointment, one whose files were tagged to remind a doctor to offer a smear during a consultation, and a comp arison control group that received opportunistic screening only. Varia ble and fixed costs for each soup were itemised and summarised to give an average cost per smear taken. The cost and effectiveness of each i ntervention were then compared with those of the control group. Sensit ivity analysis was performed on the major component of the costs, the doctor's time. Opportunistic screening cost $14.60 per smear and attai ned 16 per cent recruitment. Tagging files was the cheapest interventi on ($14.75 per smear) although it tvas the least effective in recruiti ng women (20 per cent). This result held true for different scenarios of doctor's time allocated. Intervention by invitation letter with no appointment cost $45.35 per smear and attained 26 per cent recruitment , and intervention with a specific appointment cost $48.21 per smear a nd attained 30 per cent recruitment. Compared with the control group, the incremental cost-effectiveness for the tagged soup was $15.40, for the letter-without-appointment soup $97.75 and for the letter-with-ap pointment group $86.50.