{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T12:36:45Z","timestamp":1740141405552,"version":"3.37.3"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2019,12,17]],"date-time":"2019-12-17T00:00:00Z","timestamp":1576540800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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-to-face 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>From the societal perspective, the optimal strategy was automated SMS\/phone calls\/reminders, below a threshold of \u20ac8171 per QALY; above this and below \u20ac180\u00a0878 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 \u20ac2756 and \u20ac175\u00a0463 per QALY, respectively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Assuming a willingness-to-pay threshold of one time the national gross domestic product (\u20ac22\u00a0398\/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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/eurpub\/ckz222","type":"journal-article","created":{"date-parts":[[2019,11,22]],"date-time":"2019-11-22T12:10:00Z","timestamp":1574424600000},"page":"543-552","source":"Crossref","is-referenced-by-count":3,"title":["Cost-effectiveness of a stepwise intervention to promote adherence to cervical cancer screening"],"prefix":"10.1093","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9410-633X","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Firmino-Machado","sequence":"first","affiliation":[{"name":"EPIUnit \u2013 Instituto de Sa\u00fade P\u00fablica, Universidade do Porto, Porto, Portugal"},{"name":"Unidade de Sa\u00fade P\u00fablica, ACeS Porto Ocidental, Porto, Portugal"}]},{"given":"Dj\u00f8ra I","family":"Soeteman","sequence":"additional","affiliation":[{"name":"Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA"}]},{"given":"Nuno","family":"Lunet","sequence":"additional","affiliation":[{"name":"EPIUnit \u2013 Instituto de Sa\u00fade P\u00fablica, Universidade do Porto, Porto, Portugal"},{"name":"Departamento de Ci\u00eancias da Sa\u00fade P\u00fablica e Forenses e Educa\u00e7\u00e3o M\u00e9dica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal"}]}],"member":"286","published-online":{"date-parts":[[2019,12,17]]},"reference":[{"key":"2020072014165767100_ckz222-B1"},{"key":"2020072014165767100_ckz222-B2","doi-asserted-by":"crossref","first-page":"1757","DOI":"10.1016\/S0140-6736(04)17398-4","article-title":"Efficacy of a bivalent L1 virus-like particle vaccine in prevention of infection with human papillomavirus types 16 and 18 in young women: a randomised controlled trial","volume":"364","author":"Harper","year":"2004","journal-title":"Lancet"},{"key":"2020072014165767100_ckz222-B3","first-page":"1","volume-title":"IARC Handbooks of Cancer Prevention","author":"Cheney","year":"2005"},{"key":"2020072014165767100_ckz222-B4","first-page":"201","volume-title":"IARC Handbooks of Cancer Prevention","author":"Cheney","year":"2005"},{"year":"2017","key":"2020072014165767100_ckz222-B5","first-page":"1"},{"key":"2020072014165767100_ckz222-B6","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.amepre.2008.04.002","article-title":"Client-directed interventions to increase community demand for creast, cervical, and colorectal cancer screening\u2014a systematic review","volume":"35","author":"Baron","year":"2008","journal-title":"Am J Prev Med"},{"key":"2020072014165767100_ckz222-B7","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1177\/0969141317704679","article-title":"Cost-effectiveness of strategies to increase cervical screening uptake at first invitation (STRATEGIC)","volume":"25","author":"Tsiachristas","year":"2018","journal-title":"J Med Screen"},{"key":"2020072014165767100_ckz222-B8","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1002\/ijc.27985","article-title":"Increasing participation in cervical cancer screening: telephone contact with long-term non-attendees in Sweden. 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