Modelling the Value of Integrating Digital Cellular Pathology in the United Kingdom

OBJECTIVES: To understand the value of a digital cellular pathology workflow for a representative National Health Service (NHS) hospital. Cellular pathology departments using traditional methods across the United Kingdom are under increasing pressure to meet reporting demands owing to backlogs originating from the COVID-19 pandemic, an aging population and an international shortage of pathologists. These issues have resulted in longer turnaround times and increased backlogs for referrals of all complexities and specimen types, including cancer cases.

METHODS: The research stems from the budget impact model designed to capture the value of digital cellular pathology integration. The model utilises data from Sud et al., (2020) which states that a one-day delay above the two-week reporting target results in a loss of 2.13 lifedays per referred patient. Furthermore, the model structure and further data sources were gathered and validated through engagement with key opinion leaders such as laboratory managers and histopathologists. The incremental analysis applied identifies the value of digital cellular pathology by examining the pathways of a cohort of heterogenous cases over their referral horizon whilst comparing a world with and without the digital workflow.

RESULTS: For a set of inputs aligned to a representative NHS hospital, the model predicts that the world with digital workflow removes a backlog of 5,000 cases within eleven months. The digital workflow reduces average turnaround time over time from 18.5-days to 3.5-days, where these gains are associated with approximately 14,436 incremental life-years saved over a five year horizon. Additionally, £560,000 can be saved over a five year horizon.

CONCLUSIONS: Outcomes for the backlog, turnaround times, life-years saved and monetary savings are substantially better for the digital workflow over traditional methods, for a representative NHS hospital. These conclusions strongly indicate that digital pathology integration should be considered to aid cellular pathology departments.