Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-10T15:23:30.410Z Has data issue: false hasContentIssue false
  • English
  • Français

United Kingdom cervical cancer screening and the costs of time and travel

Published online by Cambridge University Press:  01 April 2007

Claire Woolley ,
Zoë Philips ,
David K. Whynes ,
Seonaidh C. Cotton ,
Nicola M. Gray ,
Linda Sharp ,
Julian Little  and
Norman R. Waugh
Claire Woolley
Affiliation:
University of Nottingham
Zoë Philips
Affiliation:
University of Nottingham
David K. Whynes
Affiliation:
University of Nottingham
Seonaidh C. Cotton
Affiliation:
University of Aberdeen
Nicola M. Gray
Affiliation:
University of Aberdeen
Linda Sharp
Affiliation:
National Cancer Registry Ireland
Julian Little
Affiliation:
University of Ottawa
Norman R. Waugh
Affiliation:
University of Aberdeen
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: The aim of this study was to estimate the time and travel costs generated by women when attending for Papanicolaou (Pap) smear tests or colposcopy appointments in the United Kingdom, both absolutely and relative to the health service cost of the national cervical cancer screening programs.

Methods: Data were obtained from questionnaires completed by two samples of women participating in a three-center trial of management of low-grade abnormalities detected by screening (n = 1,106 for Pap smears and n = 1,203 for colposcopy appointments). Women were 20 to 59 years of age and resident in Grampian or Tayside, Scotland, or Nottingham, England. Questionnaire data were supplemented with sociodemographic information previously collected at the time of recruitment to the trial.

Results: The mean total time and travel costs per attendance at a smear test and at a colposcopy appointment were estimated to be £9.2 and £27.4, respectively, averaged across the three trial areas (valued at 2002 prices). Statistically significant intercenter disparities in time and travel costs were identified, particularly with respect to colposcopy appointments. For these, time and travel costs in Nottingham were substantially less than those in Grampian and Tayside (£22.9, £30.2, and £32.1, respectively). Time and travel costs amount to 26 and 33 percent, approximately, over and above the direct health service costs of the English and Scottish screening programs, respectively.

Conclusions: The time and travel costs associated with participation in the UK cervical cancer screening programs are substantial and are not spatially uniform across the country.

Keywords

Cervical cancerColposcopyCostsPapanicolaou testScreening
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 23 , Issue 2 , April 2007 , pp. 232 - 239
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Automobile, Association. 2006. Motoring costs 2002 (petrol cars). 2005. Available at: http://www.theaa.com/allaboutcars/advice/archive.html. Accessed January 28Google Scholar
2.Bech, M, Gyrd-Hansen, D. Cost implications of routine mammography screening of women 50-69 years in the County of Funen, Denmark. Health Policy. 2000; 54: 125–141.CrossRefGoogle ScholarPubMed
3.Bryan, S, Buxton, M, McKenna, M, Ashton, H, Scott, A. Private costs associated with abdominal aortic anuerysm screening: The importance of private time and travel costs. J Med Screen. 1995; 2: 62–66.CrossRefGoogle Scholar
4.Comptroller and Auditor General. The performance of the NHS cervical screening programme in England, HC 678 1997/98. London: National Audit Office; 1998.Google Scholar
5.Curtis, LNetten, A, eds. Unit costs of health and social care 2004. Canterbury: Personal Social Services Research Unit, University of Kent; 2004.Google Scholar
6.Cuschieri, KS, Cubie, HA. The role of human papillomavirus testing in cervical screening. J Clin Virol. 2005; 32S: S34–S42.CrossRefGoogle Scholar
7.Davey, E, Barratt, A, Irwig, L et al. , Effect of study design and quality on unsatisfactory rates, cytology classifications, and accuracy in liquid-based versus conventional cervical cytology: A systematic review. Lancet. 2006; 367: 122–132.CrossRefGoogle ScholarPubMed
8.Department, of the Environment, Transport, and the Regions. National Travel Survey, 1997-1999. London: The Stationery Office; 2003.Google Scholar
9.Department, of Transport. 2006. Values of time and operating costs, TAG unit 3.5.6. 2005. Available at: http://www.webtag.org.uk/webdocuments/3_Expert/5_Economy_Objective/3.5.6.htm. Accessed January 27Google Scholar
10.Franco, EL, Harper, DM. Vaccination against human papillomavirus infection: A new paradigm in cervical cancer control. Vaccine. 2005; 23: 2388–2394.CrossRefGoogle ScholarPubMed
11.Frew, E, Wolstenholme, JL, Atkin, W, Whynes, DK. Estimating time and travel costs incurred in clinic based screening: Flexible sigmoidoscopy screening for colorectal cancer. J Med Screen. 1999; 6: 119–123.CrossRefGoogle ScholarPubMed
12.Fryback, DG, Craig, BM. Measuring economic outcomes of cancer. J Natl Cancer Inst Monogr. 2004; 33: 134–141.CrossRefGoogle Scholar
13.Information Services Division Scotland. 2006. Number of cervical smears processed at NHS laboratories in Scotland. 2005. Available at: http://www.isdscotland.org/isd/files/cervical_cytology_TABLE_1_0106.xls. Accessed January 30Google Scholar
14.Legood, R, Gray, A, Wolstenholme, J, Moss, S. Lifetime effects, costs, and cost effectiveness of testing for human papillomavirus to manage low grade cytological abnormalities: Results of the NHS pilot studies. BMJ. 2006; 332: 79–85.CrossRefGoogle ScholarPubMed
15.Maissi, E, Marteau, TM, Hankins, M et al. , Psychological impact of human papillomavirus testing in women with borderline or mildly dyskaryotic cervical smear test results: Cross section questionnaire study. BMJ. 2004; 328: 1293–1296.CrossRefGoogle ScholarPubMed
16.Moseley, RP, Paget, S. Liquid-based cytology: Is this the way forward for cervical screening? Cytopathology. 2002; 13: 71–82.CrossRefGoogle ScholarPubMed
17.National Statistics. Labour market: New earnings survey 2002. Newport: Office of National Statistics; 2002.Google Scholar
18.National Statistics. 2006. Key statistics for the urban and rural classification 2004. 2004. Available at: http://www.statistics.gov.uk/census2001/product_ks_ur_2004.asp. Accessed January 28Google Scholar
19.Office of National Statistics. Cervical screening programme, England: 2002-3. London: ONS Statistical Bulletin 2003/24; 2003.Google Scholar
20.Orbell, S, Hagger, M, Brown, V, Tidy, J. Appraisal theory and emotional sequelae of first visit to colposcopy following an abnormal cervical screening result. Br J Health Psychol. 2004; 9: 533–555.CrossRefGoogle ScholarPubMed
21.Peto, J, Gilham, C, Fletcher, O, Matthews, FE. The cervical cancer epidemic that screening has prevented in the UK. Lancet. 2004; 364: 249–256.CrossRefGoogle ScholarPubMed
22.Philips, Z, Gray, N, Avis, M, Whynes, DK. Psychosocial and economic aspects of a trial of management of mild and borderline cervical abnormalities (TOMBOLA). Eur J Oncol Nurs. 2002; 6: 23–29.CrossRefGoogle ScholarPubMed
23.Russell, LB, Gold, MR, Siegel, JE et al. , The role of cost-effectiveness analysis in health and medicine [consensus statement]. JAMA. 1996; 276: 1172–1177.CrossRefGoogle ScholarPubMed
24.Sach, TH, Whynes, DK. Measuring indirect costs: Is there a problem? Appl Health Econ Health Policy. 2003; 2: 135–139.Google ScholarPubMed
25.Sach, TH, Whynes, DK, O'Donoghue, GM, Archbold, SM. Estimating time and out-of-pocket costs incurred by families attending a pediatric cochlear implant programme. Int J Pediatr Otorhinolaryngol. 2005; 69: 929–936.CrossRefGoogle ScholarPubMed
26.Sasieni, PD, Adams, J. Analysis of cervical cancer mortality and incidence data from England and Wales: Evidence of a beneficial effect of screening. J R Stat Soc Ser A. 2000; 163: 191–209.CrossRefGoogle Scholar
27.Schulpher, MJ, Buxton, MJ, Ferguson, BA, Spiegelhalter, DJ, Kirby, AJ. Screening for diabetic retinopathy: A relative cost-effectiveness analysis of alternative modalities and strategies. Health Econ. 1992; 1: 39–51.CrossRefGoogle Scholar
28.Scottish Executive. 2006. Urban rural classification 2003-4. 2004. Available at: http://www.scotland.gov.uk/library5/rural/seurc-00.asp. Accessed January 27Google Scholar
29.Sherlaw-Johnson, C, Philips, Z. An evaluation of liquid-based cytology and human papillomavirus testing within the UK cervical cancer screening programme. Br J Cancer. 2004; 91: 84–91.CrossRefGoogle ScholarPubMed
30.Shireman, TI, Tsevat, J, Goldie, SJ. Time costs associated with cervical cancer screening. Int J Technol Assess Health Care. 2001; 17: 146–152.CrossRefGoogle Scholar
31.Thompson, S, Wordsworth, S, for the UK Working Party on Patient Costs. An annotated cost questionnaire for completion by patients. Aberdeen: Health Economics Research Unit Discussion Paper 03/01; 2001.Google Scholar
32.Transport 2000. Facts and figures. 2005. Available at: http://www.transport2000.org.uk/factsandfigures/Facts.asp. Accessed January 27, 2006.Google Scholar
33.Walboomers, JMM, Jacobs, MV, Manos, MM et al. , Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999; 189: 12–19.3.0.CO;2-F>CrossRefGoogle ScholarPubMed
34.Waugh, N, Smith, I, Robertson, A et al. , Costs and benefits of cervical screening, I: the costs of the cervical screening programme. Cytopathology. 1996; 7: 231–240.CrossRefGoogle ScholarPubMed
35.Whynes, DK, Frew, EJ, Edwards, R, Atkin, WS. Costs of flexible sigmoidoscopy screening for colorectal cancer in the United Kingdom. Int J Technol Assess Health Care. 2003; 19: 384–395.CrossRefGoogle ScholarPubMed