RT Journal Article
SR Electronic
T1 Rapid cancer diagnosis for patients with vague symptoms: a cost-effectiveness study
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP bjgp20X708077
DO 10.3399/bjgp20X708077
A1 Bernadette Sewell
A1 Mari Jones
A1 Helen Gray
A1 Heather Wilkes
A1 Catherine Lloyd-Bennett
A1 Kim Beddow
A1 Martin Bevan
A1 Deborah Fitzsimmons
YR 2020
UL http://bjgp.org/content/early/2020/01/13/bjgp20X708077.abstract
AB Background A pilot rapid diagnosis centre (RDC) allows GPs within targeted clusters to refer adults with vague and/or non-specific symptoms suspicious of cancer, who do not meet criteria for referral under an urgent suspected cancer (USC) pathway, to a multidisciplinary RDC clinic where they are seen within 1 week.Aim To explore the cost-effectiveness of the RDC compared with standard clinical practice.Design and setting Cost-effectiveness modelling using routine data from Neath Port Talbot Hospital, Wales.Method Discrete-event simulation modelled a cohort of 1000 patients from referral to radiological diagnosis based on routine RDC and hospital data. Control patients were those referred to a USC pathway but then downgraded. Published sources provided estimates of patient quality of life (QoL) and pre-diagnosis anxiety. The model calculates time to diagnosis, costs, and quality- adjusted life years (QALYs), and estimates the probability of the RDC being a cost-effective strategy.Results The RDC reduces mean time to diagnosis from 84.2 days in usual care to 5.9 days if a diagnosis is made at clinic, or 40.8 days if further investigations are booked during RDC. RDC provision is the superior strategy (that is, less costly and more effective) compared with standard clinical practice when run near or at full capacity. However, it is not cost-effective if capacity utilisation drops below 80%.Conclusion An RDC for patients presenting with vague or non-specific symptoms suspicious of cancer in primary care reduces time to diagnosis and provides excellent value for money if run at ≥80% capacity.