{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T23:39:47Z","timestamp":1784245187751,"version":"3.55.0"},"reference-count":26,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2019,12,11]],"date-time":"2019-12-11T00:00:00Z","timestamp":1576022400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>In Lithuania, cytological screening of cervical cancer (CC) is largely opportunistic. Absence of standardized systematic invitation practice might be the reason for low participation rates. The study aimed to assess the cost-effectiveness of systematic invitation approach in CC screening programme from the perspective of a healthcare provider. A decision tree was used to compare an opportunistic invitation by a family doctor, a personal postal invitation letter with appointment time and place, and a personal postal invitation letter with appointment time and place with one reminder letter. Cost-effectiveness was defined as an incremental cost-effectiveness ratio (ICER) per one additionally screened woman and per one additional abnormal Pap smear test detected. The ICER of one personal postal invitation letter was \u20ac9.67 per one additionally screened woman and \u20ac55.21 per one additional abnormal Pap smear test detected in comparison with the current screening practice. The ICER of a personal invitation letter with an additional reminder letter compared to one invitation letter was \u20ac13.47 and \u20ac86.88 respectively. Conclusions: A personal invitation letter approach is more effective in increasing the participation rate in CC screening and the number of detected abnormal Pap smears; however, it incurs additional expenses compared with current invitation practice.<\/jats:p>","DOI":"10.3390\/ijerph16245035","type":"journal-article","created":{"date-parts":[[2019,12,12]],"date-time":"2019-12-12T03:20:16Z","timestamp":1576120816000},"page":"5035","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["The Cost-Effectiveness Analysis of Cervical Cancer Screening Using a Systematic Invitation System in Lithuania"],"prefix":"10.3390","volume":"16","author":[{"given":"Justina","family":"Paulauskiene","sequence":"first","affiliation":[{"name":"Department of Preventive Medicine, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, 47181 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2040-6900","authenticated-orcid":false,"given":"Mindaugas","family":"Stelemekas","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, 47181 Kaunas, Lithuania"},{"name":"Health Research Institute, Faculty of Public Health, Lithuanian University of Health Science, 47181 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rugile","family":"Ivanauskiene","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, 47181 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3953-8655","authenticated-orcid":false,"given":"Janina","family":"Petkeviciene","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, 47181 Kaunas, Lithuania"},{"name":"Health Research Institute, Faculty of Public Health, Lithuanian University of Health Science, 47181 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,12,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"394","DOI":"10.3322\/caac.21492","article-title":"Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"68","author":"Bray","year":"2018","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1016\/j.ejca.2018.07.005","article-title":"Cancer incidence and mortality patterns in Europe: Estimates for 40 countries and 25 major cancers in 2018","volume":"103","author":"Ferlay","year":"2018","journal-title":"Eur. J. Cancer"},{"key":"ref_3","unstructured":"Bruni, L., Albero, G., Serrano, B., Mena, M., G\u00f3mez, D., Mu\u00f1oz, J., Bosch, F.X., and de Sanjos\u00e9, S. (2019, November 15). ICO\/IARCInformation Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and RelatedDiseases in Lithuania. Summary Report 17 June 2019. Available online: https:\/\/hpvcentre.net\/statistics\/reports\/LTU.pdf."},{"key":"ref_4","unstructured":"(2019, November 13). Council Recommendation of 2 December 2003 on Cancer Screening (2003\/878\/EC). OJ L 327: 34\u201338. Available online: https:\/\/ec.europa.eu\/jrc\/sites\/jrcsh\/files\/2_December_2003%20cancer%20screening.pdf."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1093\/annonc\/mdp471","article-title":"European Guidelines for Quality Assurance in Cervical Cancer Screening. Second edition\u2014Summary document","volume":"21","author":"Arbyn","year":"2010","journal-title":"Ann. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2640","DOI":"10.1016\/j.ejca.2009.07.018","article-title":"Trends of cervical cancer mortality in the member states of the European Union","volume":"45","author":"Arbyn","year":"2009","journal-title":"Eur. J. Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.ypmed.2015.01.034","article-title":"Changes in cervical cancer incidence following the introduction of organized screening in Italy","volume":"75","author":"Serraino","year":"2015","journal-title":"Prev. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1097\/IGC.0000000000000374","article-title":"Cervical carcinoma in the European Union: An update on disease burden, screening program state of activation, and coverage as of March 2014","volume":"25","author":"Altobelli","year":"2015","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1002\/ijc.28646","article-title":"Divergent coverage, frequency and costs of organised and opportunistic Pap testing in Finland","volume":"135","author":"Salo","year":"2014","journal-title":"Int. J. Cancer"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Camilloni, L., Ferroni, E., Cendales, B.J., Pezzarossi, A., Furnari, G., Borgia, P., Guasticchi, G., and Giorgi Rossi, P. (2013). Methods to increase participation in organised screening programs: A systematic review. BMC Public Health, 13.","DOI":"10.1186\/1471-2458-13-464"},{"key":"ref_11","unstructured":"(2019, November 13). The order of the Lithuanian Minister of Health No V-482. Valstybes zinios, 3 July 2004, No. 104-3856. Available online: https:\/\/www.e-tar.lt\/portal\/en\/legalActEditions\/TAR.8FD6BCF64FD4."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2114","DOI":"10.1001\/jama.287.16.2114","article-title":"The 2001 Bethesda System: Terminology for reporting results of cervical cytology","volume":"287","author":"Solomon","year":"2002","journal-title":"JAMA"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"E677","DOI":"10.1002\/ijc.29176","article-title":"Improving cervical cancer screening attendance in Finland","volume":"136","author":"Virtanen","year":"2015","journal-title":"Int. J. Cancer"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1016\/j.ejca.2015.03.008","article-title":"Cervical cancer screening in Europe: Quality assurance and organisation of programmes","volume":"51","author":"Dillner","year":"2015","journal-title":"Eur. J. Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1097\/CEJ.0000000000000426","article-title":"Invitation strategies and coverage in the population-based cancer screening programmes in the European Union","volume":"28","author":"Vale","year":"2019","journal-title":"Eur. J. Cancer Prev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.canep.2018.10.008","article-title":"Trends in cervical cancer mortality rates in Lithuania, 1987\u20132016","volume":"57","author":"Everatt","year":"2018","journal-title":"Cancer Epidemiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"S28","DOI":"10.1016\/j.ijgo.2015.02.009","article-title":"Cancer of the cervix: Early detection and cost-effective solutions","volume":"131","author":"Denny","year":"2015","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1016\/j.jval.2015.08.003","article-title":"Using Decision-Analytic Modeling to isolate interventions that are feasible, efficient and optimal: An application from the Norwegian Cervical Cancer Screening Program","volume":"18","author":"Pedersen","year":"2015","journal-title":"Value Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"5143","DOI":"10.7314\/APJCP.2014.15.13.5143","article-title":"Cost effective analysis of recall methods for cervical cancer screening in Selangor--results from a prospective randomized controlled trial","volume":"15","author":"Rashid","year":"2014","journal-title":"Asian Pac. J. Prev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1469","DOI":"10.1093\/jnci\/94.19.1469","article-title":"Costs and benefits of different strategies to screen for cervical cancer in less-developed countries","volume":"94","author":"Mandelblatt","year":"2002","journal-title":"J. Nat. Cancer Inst."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Trapero-Bertran, M., Acera P\u00e9rez, A., de Sanjos\u00e9, S., Manresa Dom\u00ednguez, J.M., Rodr\u00edguez Capriles, D., Rodriguez Martinez, A., Bonet Sim\u00f3, J.M., Sanchez Sanchez, N., Hidalgo Valls, P., and D\u00edaz Sanchis, M. (2017). Cost-effectiveness of strategies to increase screening coverage for cervical cancer in Spain: The CRIVERVA study. BMC Public Health, 17.","DOI":"10.1186\/s12889-017-4115-0"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1159\/000327527","article-title":"A prospective randomized study of two reminding strategies: Telephone versus mail in the screening of cervical cancer in women who did not initially respond","volume":"55","author":"Heranney","year":"2011","journal-title":"Acta Cytol."},{"key":"ref_23","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. Results from RACOMIP, a randomized controlled trial","volume":"133","author":"Broberg","year":"2013","journal-title":"Int. J. Cancer"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2187","DOI":"10.1038\/bjc.2014.510","article-title":"Vaginal self-sampling is a cost-effective way to increase participation in a cervical cancer screening programme: A randomised trial","volume":"111","author":"Haguenoer","year":"2014","journal-title":"Br. J. Cancer"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"8229","DOI":"10.7314\/APJCP.2014.15.19.8229","article-title":"A systematic review of economic aspects of cervical cancer screening strategies worldwide: Discrepancy between economic analysis and policymaking","volume":"15","author":"Nahvijou","year":"2014","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.ygyno.2019.01.021","article-title":"Cost-effectiveness evaluation of HPV self-testing offered to non-attendees in cervical cancer screening in Switzerland","volume":"153","author":"Vassilakos","year":"2019","journal-title":"Gynecol. Oncol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/24\/5035\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:41:12Z","timestamp":1760190072000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/24\/5035"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12,11]]},"references-count":26,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2019,12]]}},"alternative-id":["ijerph16245035"],"URL":"https:\/\/doi.org\/10.3390\/ijerph16245035","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,12,11]]}}}