What is the impact of rerouting a cancer diagnosis from emergency presentation to GP referral on resource use and survival?

Evidence from a population-based study

Mauro Laudicella, Brendan Walsh, Elaine Burns, Paolo Li Donni, Peter C Smith

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

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Resumé

BACKGROUND: Studies on alternative routes to diagnosis stimulated successful policy interventions reducing the number of emergency diagnoses and associated mortality risk. A dearth of evidence on the costs of such interventions might prevent new policies from achieving more ambitious targets.

METHODS: We conducted a retrospective cohort study on the population of colorectal (88,051), breast (90,387), prostate (96,219), and lung (97,696) cancer patients diagnosed after a GP referral or an emergency presentation and reported in the Cancer Registry of England. Resource use and survival were compared 1 year before and 5 years after diagnosis (3 years for lung), including the costs of GP referrals not converted into a positive diagnosis. Risk-adjusted statistical models were used to calculate the effect of rerouting patient' diagnoses from emergency presentation to GP referral.

RESULTS: Rerouting a cancer diagnosis results in a relatively small additional costs to the National Health System against additional years of life saved to the patient. The cost per year of life saved is £6456 in colorectal, £1057 in breast, -£662 in prostate (savings), and £819 in lung cancer. Reducing the overall prevalence of emergency presentations to the level achieved by the 20% of Clinical Commissioning Groups with the lowest prevalence would result in £11,481,948 against 1863 years of life saved for Colorectal, £847,750 against 889 years for breast, -£943,434 (cost savings) against 1195 years for prostate, and £609,938 against 1011 years for lung cancer.

CONCLUSION: Redirecting diagnoses from emergency presentation to GP referral appears an achievable target that can produce large benefits to patients against modest additional costs to the National Health System.

OriginalsprogEngelsk
Artikelnummer394
TidsskriftBMC Cancer
Vol/bind18
Antal sider9
ISSN1471-2407
DOI
StatusUdgivet - 6. apr. 2018
Udgivet eksterntJa

Fingeraftryk

Emergencies
Referral and Consultation
Population
Neoplasms
Prostate
Lung
Cost Savings
Health
Statistical Models
England
Registries
Cohort Studies
Retrospective Studies

Citer dette

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title = "What is the impact of rerouting a cancer diagnosis from emergency presentation to GP referral on resource use and survival?: Evidence from a population-based study",
abstract = "BACKGROUND: Studies on alternative routes to diagnosis stimulated successful policy interventions reducing the number of emergency diagnoses and associated mortality risk. A dearth of evidence on the costs of such interventions might prevent new policies from achieving more ambitious targets.METHODS: We conducted a retrospective cohort study on the population of colorectal (88,051), breast (90,387), prostate (96,219), and lung (97,696) cancer patients diagnosed after a GP referral or an emergency presentation and reported in the Cancer Registry of England. Resource use and survival were compared 1 year before and 5 years after diagnosis (3 years for lung), including the costs of GP referrals not converted into a positive diagnosis. Risk-adjusted statistical models were used to calculate the effect of rerouting patient' diagnoses from emergency presentation to GP referral.RESULTS: Rerouting a cancer diagnosis results in a relatively small additional costs to the National Health System against additional years of life saved to the patient. The cost per year of life saved is £6456 in colorectal, £1057 in breast, -£662 in prostate (savings), and £819 in lung cancer. Reducing the overall prevalence of emergency presentations to the level achieved by the 20{\%} of Clinical Commissioning Groups with the lowest prevalence would result in £11,481,948 against 1863 years of life saved for Colorectal, £847,750 against 889 years for breast, -£943,434 (cost savings) against 1195 years for prostate, and £609,938 against 1011 years for lung cancer.CONCLUSION: Redirecting diagnoses from emergency presentation to GP referral appears an achievable target that can produce large benefits to patients against modest additional costs to the National Health System.",
keywords = "Emergency Medical Services, General Practitioners, Health Care Costs, Health Resources, Humans, Neoplasms/diagnosis, Population Surveillance, Prognosis, Referral and Consultation, Early diagnosis, Hospital costs, Route to diagnosis, Primary care, Survival, Emergency",
author = "Mauro Laudicella and Brendan Walsh and Elaine Burns and {Li Donni}, Paolo and Smith, {Peter C}",
year = "2018",
month = "4",
day = "6",
doi = "10.1186/s12885-018-4274-0",
language = "English",
volume = "18",
journal = "B M C Cancer",
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What is the impact of rerouting a cancer diagnosis from emergency presentation to GP referral on resource use and survival? Evidence from a population-based study. / Laudicella, Mauro; Walsh, Brendan; Burns, Elaine; Li Donni, Paolo; Smith, Peter C.

I: BMC Cancer, Bind 18, 394, 06.04.2018.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - What is the impact of rerouting a cancer diagnosis from emergency presentation to GP referral on resource use and survival?

T2 - Evidence from a population-based study

AU - Laudicella, Mauro

AU - Walsh, Brendan

AU - Burns, Elaine

AU - Li Donni, Paolo

AU - Smith, Peter C

PY - 2018/4/6

Y1 - 2018/4/6

N2 - BACKGROUND: Studies on alternative routes to diagnosis stimulated successful policy interventions reducing the number of emergency diagnoses and associated mortality risk. A dearth of evidence on the costs of such interventions might prevent new policies from achieving more ambitious targets.METHODS: We conducted a retrospective cohort study on the population of colorectal (88,051), breast (90,387), prostate (96,219), and lung (97,696) cancer patients diagnosed after a GP referral or an emergency presentation and reported in the Cancer Registry of England. Resource use and survival were compared 1 year before and 5 years after diagnosis (3 years for lung), including the costs of GP referrals not converted into a positive diagnosis. Risk-adjusted statistical models were used to calculate the effect of rerouting patient' diagnoses from emergency presentation to GP referral.RESULTS: Rerouting a cancer diagnosis results in a relatively small additional costs to the National Health System against additional years of life saved to the patient. The cost per year of life saved is £6456 in colorectal, £1057 in breast, -£662 in prostate (savings), and £819 in lung cancer. Reducing the overall prevalence of emergency presentations to the level achieved by the 20% of Clinical Commissioning Groups with the lowest prevalence would result in £11,481,948 against 1863 years of life saved for Colorectal, £847,750 against 889 years for breast, -£943,434 (cost savings) against 1195 years for prostate, and £609,938 against 1011 years for lung cancer.CONCLUSION: Redirecting diagnoses from emergency presentation to GP referral appears an achievable target that can produce large benefits to patients against modest additional costs to the National Health System.

AB - BACKGROUND: Studies on alternative routes to diagnosis stimulated successful policy interventions reducing the number of emergency diagnoses and associated mortality risk. A dearth of evidence on the costs of such interventions might prevent new policies from achieving more ambitious targets.METHODS: We conducted a retrospective cohort study on the population of colorectal (88,051), breast (90,387), prostate (96,219), and lung (97,696) cancer patients diagnosed after a GP referral or an emergency presentation and reported in the Cancer Registry of England. Resource use and survival were compared 1 year before and 5 years after diagnosis (3 years for lung), including the costs of GP referrals not converted into a positive diagnosis. Risk-adjusted statistical models were used to calculate the effect of rerouting patient' diagnoses from emergency presentation to GP referral.RESULTS: Rerouting a cancer diagnosis results in a relatively small additional costs to the National Health System against additional years of life saved to the patient. The cost per year of life saved is £6456 in colorectal, £1057 in breast, -£662 in prostate (savings), and £819 in lung cancer. Reducing the overall prevalence of emergency presentations to the level achieved by the 20% of Clinical Commissioning Groups with the lowest prevalence would result in £11,481,948 against 1863 years of life saved for Colorectal, £847,750 against 889 years for breast, -£943,434 (cost savings) against 1195 years for prostate, and £609,938 against 1011 years for lung cancer.CONCLUSION: Redirecting diagnoses from emergency presentation to GP referral appears an achievable target that can produce large benefits to patients against modest additional costs to the National Health System.

KW - Emergency Medical Services

KW - General Practitioners

KW - Health Care Costs

KW - Health Resources

KW - Humans

KW - Neoplasms/diagnosis

KW - Population Surveillance

KW - Prognosis

KW - Referral and Consultation

KW - Early diagnosis

KW - Hospital costs

KW - Route to diagnosis

KW - Primary care

KW - Survival

KW - Emergency

U2 - 10.1186/s12885-018-4274-0

DO - 10.1186/s12885-018-4274-0

M3 - Journal article

VL - 18

JO - B M C Cancer

JF - B M C Cancer

SN - 1471-2407

M1 - 394

ER -