Rapid cancer diagnosis for patients with vague symptoms: a cost-effectiveness study

Abstract

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.

Keywords: cancer diagnosis; cost-effectiveness; early detection of cancer; general practice; non-specific symptoms; rapid diagnosis centre.

Figure 1.

Schematic of the patient pathway through the rapid diagnosis centre (RDC) in the model intervention group. CNS = cancer nurse specialist. CT = computed tomography. MDT = multidisciplinary team.

Figure 2.

Cost-effectiveness acceptability curve summarising results of probabilistic sensitivity analysis across 1000 runs assuming 2.78 patients per clinic at different WTP thresholds. WTP = willingness-to-pay.