From cost-effectiveness information to decision-making on liquid-based cytology: Mind the gap.
OBJECTIVE
This paper explores the policy process involved in the production of cost-effectiveness information in the context of both national and local policy-making requirements. We use the decision to implement a new technology for cervical cancer screening (liquid-based cytology) in England as a case study.


METHODS
The analysis traces the initial decision by the National Institute of Health and Clinical Excellence to commission further research before implementing this new technology, the economic data produced as a result, the final decision nationally and the implications for decision-makers locally.


RESULTS
The paper highlights a number of reasons why there may be a gap between the evidence produced by a cost-effectiveness analysis and the information needs of the decision-maker. For example there are difficulties in estimating whether savings in staff time are realisable. In addition, even after a technology has been deemed cost-effective and is recommended for national implementation, further questions remain at the local level, including identifying the most cost-effective way to implement a technology, and selecting the best supplier.


CONCLUSIONS
In order to make cost-effective implementation decisions, local decision-makers require economic data in addition to that required for the national recommendation, and this deserves recognition and further research.
Legood
Rosa
R
Health Services Research Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom. rosa.legood@lshtm.ac.uk
Wolstenholme
Jane
J
Gray
Alastair
A
D026683:Advisory Committees; D003362:Cost-Benefit Analysis; D003581:Cytodiagnosis / Q000191:economics* / Q000379:methods*; D003657:Decision Making; D004059:Diffusion of Innovation; D004739:England; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D010865:Pilot Projects; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis