Putting National Institute for Health and Clinical Excellence guidance into practice: A cost minimization model of a national roll-out of liquid based cytology in England

Objectives: In 2003, the National Institute for Health and Clinical Excellence (NICE) advised that liquid based cytology (LBC) should be adopted for cervical screening in England. The aim of this study was to explore the cost implications of implementing the NICE guidance in cytology laboratories. The ThinPrep® technology was used as the case study. Methods: An optimization model was developed to analyze options for leasing alternative LBC processing machines with different capacities. Variables entered in the model included: the cost of the contract with the supplier, the laboratory labor cost, and inter-laboratory transport costs. All costs referred to the 2005–06 financial year. A simulation program calculated mileages within laboratory networks. Alternative strategies for contracting by laboratories acting independently and by Quality Assessment Regional Centres (QARC) were analyzed. Results: Centralizing the processing of specimens in “hub and spoke” laboratory networks was the least costly strategy. Total annual costs for England using existing transport links were £14,807,000 for 5-year contracts. If all laboratories installed processors, the annual cost for 5-year contracts placed by QARCs was £14,941,000 compared with £16,359,000 if the laboratories placed their own contracts. Three-year contracts averaged an additional £1 million: £15,912,000 for networks and £17,304,000 for independent laboratory contracts. Conclusions: Deciding on the mode of implementation of a NICE guidance can be challenging for decision makers. These cost minimization appraisal techniques are equally applicable to national screening programs in general and to other health technologies for which there are significant cost implications associated with innovative policy directives.