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. CONCLUSION: 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.