Anxiety amongst women with mild dyskaryosis: costs of an educational intervention

A randomized controlled trial in primary care investigated whether a structured educational intervention had an impact on the psychological morbidity associated with a 6-month period of surveillance for mild dyskaryosis. In the context of high levels of sustained distress, and few differences in terms of objective measures of anxiety, the intervention led to a greater proportion of women who were comfortable with a 6-month interval before their next smear test. OBJECTIVE. The aim of this paper is to evaluate the implications to general practices and the NHS, in terms of both costs and numbers of patient contacts, of a change from current policy to one of actively inviting all women with mild dyskaryosis to consult the practice nurse for the intervention.

We conducted a pragmatic, cluster-randomized controlled trial, comparing the intervention with standard care. The setting was general practices in Avon and South Glamorgan, UK. The subjects were women under surveillance following their first ever mildly dyskaryotic cervical smear result. The main outcome measures were as follows. Costs were reported according to randomization group, from the viewpoint of general practices and the NHS. The main elements which were costed were those attributable to production of the package and training in its use, and the costs of consultations subsequent to the woman receiving her smear test result. In addition, since in practice the intervention might be applied in different circumstances to those prevailing in the trial, a sensitivity analysis was performed to assess the costs of the educational package as realistically as possible.

Almost twice as many women in the intervention group compared with the control group visited their practice to discuss their result. From the perspective of the practices, a change from current policy to the intervention policy led to potential (negligible) savings of around pound sterling 3.50 per partner per year. From the NHS perspective, the intervention would lead to slightly increased costs of between pound sterling 1000 and pound sterling 2500 per year for an area performing 60000 tests per year.

It is both feasible and acceptable for practice nurses to deliver the educational package. Moreover, from the perspective of a practice, the policy is effectively cost-neutral. The main implication for general practices is the change in the pattern of care provided: fewer women consulted their GP about their smear result and many more, following active encouragement, consulted the practice nurse.