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From cost-effectiveness information to decision-making on liquid-based cytology: Mind the gap


  • Legood, Rosa
  • Wolstenholme, Jane
  • Gray, Alastair


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.

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  • Legood, Rosa & Wolstenholme, Jane & Gray, Alastair, 2009. "From cost-effectiveness information to decision-making on liquid-based cytology: Mind the gap," Health Policy, Elsevier, vol. 89(2), pages 193-200, February.
  • Handle: RePEc:eee:hepoli:v:89:y:2009:i:2:p:193-200

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    References listed on IDEAS

    1. Locock, Louise & Dopson, Sue & Chambers, David & Gabbay, John, 2001. "Understanding the role of opinion leaders in improving clinical effectiveness," Social Science & Medicine, Elsevier, vol. 53(6), pages 745-757, September.
    2. Drummond, Michael & Cooke, Jonathan & Walley, Tom, 1997. "Economic evaluation under managed competition: Evidence from the U.K," Social Science & Medicine, Elsevier, vol. 45(4), pages 583-595, August.
    3. Ross, Jayne, 1995. "The use of economic evaluation in health care: Australian decision makers' perceptions," Health Policy, Elsevier, vol. 31(2), pages 103-110, February.
    4. Stirling Bryan & Iestyn Williams & Shirley McIver, 2007. "Seeing the NICE side of cost-effectiveness analysis: a qualitative investigation of the use of CEA in NICE technology appraisals," Health Economics, John Wiley & Sons, Ltd., vol. 16(2), pages 179-193.
    5. Duthie, Tessa & Trueman, Paul & Chancellor, Jeremy & Diez, Lara, 1999. "Research into the use of health economics in decision making in the United Kingdom--Phase II: Is health economics `for good or evil'?," Health Policy, Elsevier, vol. 46(2), pages 143-157, January.
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