The Cost-Effectiveness Analysis of Cervical Cancer Screening Using a Systematic Invitation System in Lithuania.

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 €9.67 per one additionally screened woman and €55.21 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 €13.47 and €86.88 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.

Organised Versus Opportunistic Cervical Cancer Screening in Urban and Rural Regions of Lithuania.

Background and Objectives: In 2004, Lithuania started the Nationwide Cervical Cancer Screening Programme. However, screening is more opportunistic than population-wide and the programme's coverage is insufficient. The aim of this study was to assess the effect of systematic personal invitation on coverage of cervical cancer (CC) screening in urban and rural regions of Lithuania. Materials and Methods: The study was conducted in an urban primary healthcare centre (PHCC) and in a rural PHCC, where prevailing CC screening practice was highly opportunistic. Over the first year, all women aged 25-60 who had not received a Pap smear test within the last three years in urban (n = 1591) and rural (n = 1843) PHCCs received a personal invitation letter to participate in the screening. Over the second year, the reminder letter was sent to the non-attendees (n = 1042 in urban and n = 929 in rural PHCCs). A random sample of women (n = 93), who did not attend for screening after two letters, was contacted by phone in order to identify the barriers of non-attendance. Results: Before the study, only 9.6% of the target population in urban and 14.7% in rural PHCCs participated in CC screening. After the first invitation letter, the participation in CC screening increased up to 24.6% in urban and 30.8% in rural areas (p < 0.001). After the reminder letter, the attendance was 16.4% in urban and 22.2% in rural PHCCs (p < 0.001). The most common barriers for the non-attendance were lack of time, long waiting time for family doctor's appointment, worries that a Pap test might be unpleasant and preventive gynaecological examination outside of the screening program. Conclusions: A systematic personal invitation with one reminder letter significantly increased the coverage of CC screening and was more effective in rural regions than in urban regions. The assessed barriers for non-attendance can be used to improve the coverage of screening.

The cost of newly diagnosed breast cancer in Lithuania, 2011.

BACKGROUND AND OBJECTIVE: Although the cost of treating women with breast cancer (BC) is an important component for cost saving and effectiveness in relation to the benefits of BC treatment interventions, there is limited information on the direct cost reported for BC in Lithuania. Therefore the aim of this study was to evaluate annual direct medical cost for newly diagnosed BC in Lithuania in the year 2011. MATERIALS AND METHODS: The retrospective incidence-based top-down direct cost analysis was used. From January 1 to December 31, 2011 incident cases of BC (N=1142) registered by the National Health Insurance Fund, the stage determined by Lithuanian Cancer Registry were included in the study. RESULTS: The total average direct cost of BC amounted per patient was 2580 (95% CI 2444-2752)EUR in 2011. The main cost driver per BC patients was the inpatient hospital stay, respectively 1655 (95% CI 1478-2334)EUR. The average outpatient cost for one BC patient was 564 (95% CI 547-898)EUR. The dominant proportion of inpatient expenditures was assigned to BC surgery and chemotherapy treatment. The BC direct medical cost increased according to the diagnosed stage of diseases from 2409 (95% CI 2196-2621)EUR in stage 1 to 3688 (95% CI 2703-4672)EUR in stage 4. The direct medical cost was inversely proportional to age. CONCLUSIONS: The direct BC medical cost estimates provided by this analysis can be used to determine priorities for the future research on BC treatment interventions.

Direct cost of patients with type 2 diabetes mellitus healthcare and its complications in Lithuania.

OBJECTIVE: The main objective of this study was to estimate the annual direct healthcare cost of type 2 diabetes mellitus healthcare and its complications in Lithuanian population. MATERIAL AND METHODS: The study uses a prevalence-based top-down approach. The random sample of study participants was formed using the database of the National Health Insurance Fund under the Lithuanian Ministry of Health. 762 patients with diabetes mellitus type 2 data were analyzed in this research. The data on healthcare costs was recorded between January 1, 2011 and December 31, 2011. RESULTS: Ambulatory care cost mean per patients with diabetes mellitus type 2 in 2011 was EUR 156.14 (95% CI, 147.05-165.24). 34.4% patients had at least one hospitalization during the 2011 year. Mean annual cost per patients of hospitalization was EUR 1160.16 (95% CI, 1019.60-1300.73). Covered drugs and diabetes supplies annual direct cost mean per patients was EUR 448.34 (95% CI, 411.14-485.54). The more expensive treatment was with oral and non-insulin injectable hypoglycemic medications (P<0.001). 65.1% participants were diagnosed one or more diabetes-related chronic complications. Average annual cost per person, increased gradually with the numbers of complications from EUR 671.94 (95% CI, 575.03-768.86) in patients without complications to EUR 1588.98 (95% CI, 1052.09-2125.86) in patients with 3 and more complications (P<0.001). CONCLUSIONS: The largest part of direct costs in diabetes mellitus healthcare composes hospital inpatient care and covered drugs expenditures. In our study we observed that the presence of microvascular, macrovascular chronic complication increased the direct cost per patient, compared with patients without complications.

Well-being of newly diagnosed women with breast cancer: which factors matter more?

BACKGROUND: The assessment of health-related quality of life (HRQL) in newly diagnosed breast cancer patients is necessary to address predictive factors in supportive clinical practice. PURPOSE: The objectives of this study are to evaluate self-reported HRQL within 1 year after breast cancer diagnosis and to determine important factors associated with self-reported impaired HRQL. METHODS: A cross-sectional study was performed in newly diagnosed breast cancer patients. The statistical analysis included descriptive statistics and stepwise logistic regression modeling. RESULTS: The survey response rate was 67 % (n = 338). Almost 50 % of the studied population was identified as experiencing anxiety. The impaired HRQL domains were emotional functioning and global health status. Severely expressed symptoms included insomnia, fatigue, and financial difficulties. Poor financial situation, comorbidities, unemployment, and lack of psychological counseling were identified as important predictive factors (p < 0.001). CONCLUSIONS: Psychosocial, but not clinical, factors were the prevalent predictive factors in impaired HRQL. Early identification of women that are at risk of poorer HRQL and interventions of psychosocial support following breast cancer diagnosis are recommended.

Survival of women with breast cancer in Kaunas Region, Lithuania.

OBJECTIVE. The assessment of breast cancer survival rates and comparison with those of other countries may help to deepen knowledge among decision makers in the health care system and to improve the inequalities in accessibility to early detection and effective treatment. The aim of this study was to evaluate breast cancer survival rates in Kaunas region, Lithuania, and to compare them with those in the selected European countries. MATERIAL AND METHODS. A retrospective study was carried out using medical records and data gathered from the Lithuanian Cancer Registry. A group of 240 patients with primary breast cancer diagnosed in 2008 in Kaunas region was analyzed. All causes of death were included in the analysis. The closing date of follow-up was September 30, 2010. Survival was determined using the life-table method and the Kaplan-Meier method. Cox proportional hazard models were used to estimate the effects of prognostic risk factors on survival. RESULTS. The median age of the patients was 63 years (range, 28-95). The 1-year and 2-year cumulative survival for breast cancer patients in Kaunas region, Lithuania, was 94.2% and 90.1%, respectively. As expected, the survival of patients with diagnosed advanced disease (stage III and IV) was significantly worse than that of patients with stage I (P<0.001) and II (P=0.003) disease. The screening group (aged 50-69 years) showed better survival in comparison with the group older than 69 years. Age, T4 tumor, and distant metastasis were the prognostic factors significantly associated with an increased relative mortality risk of breast cancer. CONCLUSIONS. Compared to the European survival rates, the 1-year and 2-year survival of patients with breast cancer in Lithuania was found to be similar to most European countries.

Evaluation of health-related quality of life in patients with breast cancer.

BACKGROUND: Breast cancer is the most common cancer among women, comprising about 23% of all cancer types. About 1300 new cases of breast cancer are registered in Lithuania annually. During the last decade, health-related quality of life has become an important part of breast cancer treatment. Pain, fatigue, and sleep disorders are important aspects of health-related quality of life. The aim of the study was to evaluate health-related quality of life (HRQL) among patients with breast cancer in Lithuania. The main tasks were to analyze HRQL in sociodemographic and clinical aspects, and to determine symptoms that have the greatest impact on HRQL . MATERIAL AND METHODS: A cross-sectional study was carried out in four major Lithuanian hospitals. An EORTC QLQ-C30 (version 3) questionnaire with general demographic and medical information was distributed among 318 patients. A total of 284 patients were included in the analysis. RESULTS: The response rate was 89%. The mean age of patients was 55.9 years (SD, 10.1 years), and the mean time from diagnosis--2.36 years (SD, 3.2 years). A greater part (65%) of the studied women lived in a family or with a partner. Women reported high level of functioning across several standardized HRQOL scales: cognitive functioning, everyday activity, and physical functioning. Fatigue and sleeping disorders were the most commonly indicated symptoms in the symptom scale. Fatigue and pain were the most important factors affecting general HRQOL. CONCLUSIONS: Our results emphasize that the general HRQOL of the studied women is fair, but poorer than that of the corresponding population in other countries. Women living in a family or partnership experienced fewer financial troubles and had higher HRQOL scores across several standardized measures compared to those who were single. Women with late stages of breast cancer felt worse and were less socially active compared to women who were diagnosed with early-stage breast cancer.