Guidance on the use of liquid-based cytology for cervical screening

Information in the pilot studies estimated a one-off cost of £10.1 to £10.3 million for the conversion from Pap smears to LBC in England, which equates to a cost of approximately £73,000 for a local laboratory processing 30,000 tests per annum. These figures only include the cost of training smear takers and laboratory staff, producing training material, sending off a backlog of samples, and structural changes to the laboratory and assume that all GPs and nurses will be trained in the use of LBC. Proportionately similar costs will be incurred in Wales. In both countries the precise costs will be a function of the number and size of laboratories undertaking LBC. The cost of acquiring the LBC slide preparation equipment itself has not been estimated because there are a number of possible solutions that could alter the nature and timing of the cost impact. These solutions should be investigated fully, as part of implementation planning taking into full consideration the cost of consumables and maintenance, as part of a whole life cost analysis demonstrating a value for money solution to the NHS. In England, the NHS Purchasing and Supply Agency will evaluate options for the purchase of capital equipment. Procurement in Wales will be managed on an all-Wales basis by the West Wales Procurement Consortium. If sample preparation using LBC is to be centralised in regional laboratories, consideration will need to be given to the logistics and costs associated with sample transport and communication of the central processing laboratories with the local reporting laboratories.

The English pilot report estimated the running costs of Pap smears and LBC to be comparable, and with LBC time savings in the diagnosis of smears may contribute to increased laboratory productivity. In addition, increases in laboratory productivity may reduce the time that patients need to wait for the results of a smear test. The use of LBC in accordance with this guidance is likely to release resources within NHS organisations, although the nature and amounts involved will vary between local NHS communities.

Existing smear takers and laboratory staff will need additional training in the LBC method before implementation of the recommendation in section 1.1. Training of new smear takers and laboratory staff in the LBC method is likely to require similar resources to those for the training of staff in Pap smears.

The rate at which LBC is taken up throughout the NHS in England and Wales will depend on a number of logistical factors, which should be determined by the NHSCSP and Cervical Screening Wales with the involvement of the NHS Purchasing and Supplies Agency and the West Wales Procurement Consortium. During this period, the standard cervical screening method will need to run in parallel.