Introduction Colonoscopy effectively excludes bowel cancer as a cause for a patient’s symptoms but may result in cross-sectional imaging further along the pathway and CT colonography (CTC) may address both issues. We propose to pilot a straight to test (STT) model where patients 75 years and over undergo CTC as routine, and assessed the potential financial benefit of this.
Methods Data from 2 week wait referrals for suspected colorectal cancer to UCLH between June 12th 2014 to November 17th 2014 was analysed retrospectively from hospital systems. Data was collected from the time of referral until discharge from the pathway. Using the NHS tariffs (to nearest £) for each investigation/procedure, we calculated the potential financial benefit by directly comparing actual costs incurred versus the potential costs using the STT model.
Results In total, 505 patients were referred, with 477 of these patients sent for further tests; 353 referred for endoscopy (332 colonoscopy), and 110 referred for CTC. The average age of patients for endoscopy was 59.3 years versus 71 years for CTC. In the endoscopy group, 46 patients were aged 75 or older (13%). Table 1 details the costs incurred (excluding staging CT).
Had all 46 patients had a CTC initially, this would have resulted in a cost of £10948 and follow up costs for endoscopy would have been as per further procedures as in Table 1 (£1860 + £4690 + £309), resulting in a total of £17807. In the 5 month period analysed, a potential saving of £3735 using the STT model, representing a potential annual saving of £8964.
Conclusion Potentially ≈ £9000 per annum could be saved using the STT model proposed, and could also have eased pressure on endoscopy capacity. Further increases on financial savings include careful referral to endoscopy after CTC.
Extra-colonic organ review is offered by CTC and may reduce the need for further imaging, and account for those requring CT post endoscopy. A third of patients are estimated to require endoscopy after CTC in the STT model, and although this may increase patient distress and inconvenience due to multiple tests, it allows targeted therapeutic colonoscopy. STT has also been demonstrated to reduce outpatient clinic appointments, thereby reducing costs not analysed in this analysis. However, a trained nurse is required which involves expenditure but is associated with greater patient satisfaction.
Disclosure of Interest None Declared
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