Cost-effectiveness of a stepwise intervention to promote adherence to cervical cancer screening

Background: Cervical cancer screening is effective in reducing mortality, but adherence is generally low. We aimed to investigate the cost-effectiveness of a stepwise intervention to promote adherence to cervical cancer screening in Portugal. Methods: We developed a decision tree model to compare the cost-effectiveness of four competing interventions to increase adherence to cervical cancer screening: (i) a written letter (standard-of-care); (ii) automated short message service text messages (SMS)/phone calls/reminders; (iii) automated SMS/phone calls/ reminders + manual phone calls; (iv) automated SMS/phone calls/reminders + manual phone calls + face-toface interviews. The main outcome measure was cost per quality-adjusted life year (QALY) measured over a 5-year time horizon. Costs were calculated from the societal and provider perspectives. Results: From the societal perspective, the optimal strategy was automated SMS/phone calls/reminders, below a threshold of (sic)8171 per QALY; above this and below (sic)180 878 per QALY, the most cost-effective strategy was automated SMS/phone calls/ reminders + manual phone calls and above this value automated SMS/phone calls/reminders + manual phone calls + face-to-face interviews. From the provider perspective, the ranking of the three strategies in terms of cost-effectiveness was the same, for thresholds of (sic)2756 and (sic)175 463 per QALY, respectively. Conclusions: Assuming a willingness-to-pay threshold of one time the national gross domestic product ((sic)22 398/QALY), automated SMS/ phone calls/reminders + manual phone calls is a cost-effective strategy to promote adherence to cervical cancer screening, both from the societal and provider perspectives.