Anxiety amongst women with mild dyskaryosis: costs of an educational intervention

Background. A randomized controlled trial in primary care investigated whet her a structured educational intervention had an impact on the psychologica l morbidity associated with a 6-month period of surveillance for mild dyska ryosis. In the context of high levels of sustained distress, and few differ ences in terms of objective measures of anxiety, the intervention led to a greater proportion of women who were comfortable with a 6-month interval be fore their next smear test. Objective. The aim of this paper is to evaluate the implications to general practices and the NHS, in terms of both costs and numbers of patient conta cts, of a change from current policy to one of actively inviting all women with mild dyskaryosis to consult the practice nurse for the intervention. Methods. We conducted a pragmatic, cluster-randomized controlled trial, com paring the intervention with standard care. The setting was general practic es in Avon and South Glamorgan, UK. The subjects were women under surveilla nce following their first ever mildly dyskaryotic cervical smear result. Th e main outcome measures were as follows. Costs were reported according to r andomization group, from the viewpoint of general practices and the Ni-IS. The main elements which were costed were those attributable to production o f the package and training in its use, and the costs of consultations subse quent to the woman receiving her smear test result. In addition, since in p ractice the intervention might be applied in different circumstances to tho se prevailing in the trial, a sensitivity analysis was performed to assess the costs of the educational package as realistically as possible. Results. Almost twice as many women in the intervention group compared with the control group visited their practice to discuss their result. From the perspective of the practices, a change from current policy to the interven tion policy led to potential (negligible) savings of around pound 3.50 per partner per year. From the NHS perspective, the intervention would lead to slightly increased costs of between pound 1000 and pound 2500 per year for an area performing 60 000 tests per year. Conclusions. It is both feasible and acceptable for practice nurses to deli ver the educational package. Moreover, from the perspective of a practice, the policy is effectively cost-neutral. The main implication for general pr actices is the change in the pattern of care provided: fewer women consulte d their GP about their smear result and many more, following active encoura gement, consulted the practice nurse.