Public Health Wales / Business Case Template
Business case for the phased introduction of HPV Testing in Wales
Author:Rhys Blake, Divisional General Manager, Screening
Date:14th May 2013 / Version:1.0
Purpose and Summary of Document:
To make a case for the phased introduction of HPV testing in Wales
Financial Framework approved by Financial Manager: Insertname of financial manager
Signature of Financial Manager:
Name of Director: Dr Rosemary fox
Signature of Director:
Work Plan reference: CRAMP (CSW reconfiguration and modernisation project)

1DESCRIPTION

Title / Introduction of HPV for test of cure (clearance) and triage in cytology
Area of Public Health Wales / Screening Division

2NEED

Definition of Need / To introduce HPV testing into the programme to enhance screening and clinical assessment and to enable the expected shift to HPV as a primary test, in a timely and seamless manner
Strategic Context / UK wide introduction of HPV testing
Local Context / Cervical Screening Wales reconfiguration and modernisation project

3OUTLINE PROPOSAL

Existing Service / Currently there is no HPV testing provided in Waleswhilst England, Scotland and Northern Ireland are rapidly rolling out HPV testing
Proposal / To introduce HPV into the programme in a phased manner in order to offset and manage any change in emphasis and resources and minimise impact on either cytology services or colposcopy services
Benefits / Test of Cure
Ensure a significant cohort of women currently on 10 year annual follow up can be returned to routine recall.
Triage
To enable the programme to more accurately identify women who would benefit from colposcopy and make a more informed risk based decision about those who can safely be returned to routine recall
Resolution of Uncertainty
HPV testing can also be used to assist clinical decisions at colposcopy in diagnostically difficult cases (eg persistent low grade abnormalities.
Benefits therefore in a reduction in unnecessary colposcopies, savings on outpatient activity and an overall reduction in harm and risk
Impact / Financial (medium to long term)
Clinical (immediate)
Support / The introduction of HPV testing is widely supportedwithin the Division, the Trust and Welsh Government
Evaluation / Evaluation of HPV testing will be reported through the usual national channels (CSW statistical Report etc)

4OPTION APPRAISAL

Options / Option 1: Do nothing
Option 2: Introduce TOC (Test of cure/clearance) only
Option 3: Introduce TOC and TIC(Triage in cytology)
Option 4: Introduce HPV as primary test
Option 5: Introduce TOC as part of a phased move to primary testing
Selection Criteria / Weightings out of 5 (max score 20)
Affordability: Weighting 3
Service impact: Weighting 3
Clinical impact: Weighting 4
Patient benefit: Weighting 5
Evaluation of the Options / Affordability / Service impact / Clinical impact / Patient benefit / Score
Option 1: do nothing / 5 / 5 / 0 / 0 / 10
Option 2: Introduce TOC only / 4 / 4 / 4 / 2 / 14
Option 3: Introduce TOC & TIC / 3 / 2 / 3 / 3 / 11
Option 4: Introduce primary HPV testing / 1 / 1 / 4 / 5 / 11
Option 5: Introduce TOC as part of phased move towards primary testing / 5 / 5 / 5 / 4 / 19
The highest scoring option by a clear margin is to take a phased approach

5COST

Revenue costs - recurring / The following costs are derived from an existing and current national framework contract
Based on a 2 – 2.5% TOC rate of testing at cost of £7.30 per test - £41,975
Based on 5-7% TIC rate of testing at a cost of £7.30 per test
£75,555 - £83,950
Revenue costs – non recurring / 0
Capital Costs / 0
Expenditure Profile / Yr 1 / Yr 2 / Yr 3 / Yr 4
Cost of testing / 41,975 / 117,530 / 117,530 / ?primary
Savings on LBC consumables / 23,000 / 23,000 / 23,000
Reduction in Chester Contract & Hywel Dda Cytology / 77,426 / 77,426
Net investment required / 18,975 / Fully Funded / Fully funded
Source of funds / Yr 1 Additional recurring efficiencies
Source(s) of funds / Currently uncommitted funds sitting within the division as a result of late LTA renegotiation with Countess of Chester would fund this development.
Future savings would be realised though a streamlining of work in colposcopy and significant staff savings in screening workload. These cannot be quantified at this stage.

6FEASIBILITY

3 Year Financial Framework / The introduction of TIC and TOC is feasible over a three year contract
Sustainability / The introduction of HPV testing assures a sustainable programme going forward
Implementation / A project has been established to take forward the modernisation of the service

7IMPLICATIONS OF DOING NOTHING

Risks / At some point the provision of cytology will become unsustainable. There are no new screeners being trained and the effect of HPV vaccination will see a shift to the detection of high risk HPV types as the indicator for further investigation as opposed to cytological changes alone. As HPV is being introduced across the UK, the eligible population in Wales is currently receiving a lower level of service. It is imperative therefore that to keep pace with the rest of the UK that CSW introduces HPV. It is considered that this phased approach is the lowest risk way of implementing.
Date:12th June / Version: 1.0 / Page:1 of 5
Public Health Wales / Business Case Template

Appendix – Equality & Diversity Impact Assessment

Background

When contemplating a new project, or significant changes to existing policies or services, the planning process should take into account health determinants, especially their effect on disadvantaged groups. Services and amenities should be targeted according to need. This means that those who are most disadvantaged should be prioritised and protected from negative health impacts.

This checklist focuses on vulnerable groups and completing it at an early stage of the planning process will assist planners to address these issues. Many negative responses in section 2 may indicate the need for a more detailed assessment.

Please see:

for guidance on the completion of this assessment.

Section 1

Whose needs is this paper designed to address? (e.g. whole administrative area, a named, prioritised group)
What is the paper designed to achieve?
Will people whom the paper could potentially benefit be subject to access problems? Please consider matters such as location, gender of practitioner, medium and language.

Section 2

Please consider the following issues and briefly describe in the appropriate box the paper’s potential impacts.

Population Characteristic / Potential Impact on Health
Positive / Negative / No Change
Material disadvantage (e.g. low income, no car, poor housing, unemployment, homelessness)
Minority culture or ethnic group (e.g. those who find communication in English difficult, cultural and religious beliefs)
Families with children (e.g. pregnant women, babies, children and teenagers)
Physical or mental frailty (e.g. advanced age, learning difficulties, physical disability, carers)
Gender or sexuality (e.g. access to services, issues of prejudice)
How will the impact of this paper on health in general and vulnerable groups in particular be monitored?
Date: / Version: / Page:1 of 8