INFORMING ECONOMIC MODEL CONCEPTUALISATION WITH A CARE PATHWAY ANALYSIS FOR A ROBOT-ASSISTED BRONCHOSCOPY PLATFORM FOR SUSPICIOUS PULMONARY NODULES IN THE UK
Author(s)
Karina Watts, MBiolSci1, Emily Gregg, PhD1, James Lavin, MSc2, Ritu Finnerty, MSc3, Rachele Busca, MBA, MSc, PharmD2, Frank O'Neill, PhD2, Hayden Holmes, PGDipPH1.
1York Health Economics Consortium, York, United Kingdom, 2Intuitive Surgical, Aubonne, Switzerland, 3Intuitive Surgical, Sunnyvale, CA, USA.
1York Health Economics Consortium, York, United Kingdom, 2Intuitive Surgical, Aubonne, Switzerland, 3Intuitive Surgical, Sunnyvale, CA, USA.
OBJECTIVES: Biopsy of suspicious pulmonary nodules is a key step in confirming lung cancer. As a result of the Lung Cancer Screening Programme in the UK, smaller and more peripheral nodules are being sent for biopsy, with associated challenges. A novel robot-assisted bronchoscopy (RAB) platform has been developed. We conducted a care pathway analysis (CPA) to identify the current UK clinical pathway for suspicious lung nodules, variation in practice and the potential value of RAB. This informed conceptualisation of a cost-effectiveness model.
METHODS: Semi-structured individual interviews were conducted in August/September 2025. Seven clinicians with experience in managing pulmonary nodules were recruited using purposive sampling. A draft care pathway, based on national guidelines, was discussed during the interviews, along with questions about variation in practice and the potential positioning/value of RAB. Thematic analysis/synthesis was undertaken, and a final care pathway diagram was produced.
RESULTS: The CPA identified important differences between clinical guidelines and clinical practice, as well as geographic variation. Although the choice of biopsy technique is influenced by nodule/patient characteristics, all clinicians agreed the availability of biopsy techniques in each centre plays a role: some use electromagnetic navigation bronchoscopy and others computed tomography-guided biopsy as first choice. All experts agreed there was potential value of RAB, including increasing biopsy eligibility for smaller, more peripheral nodules; allowing biopsy and staging in one procedure; reducing repeat scans; and allowing more confident diagnosis. Based on the pathway, a 20% increase in biopsy eligibility could reduce watch-and-wait referrals (265 to 262) and increase biopsy numbers (559 to 563) per 1,000 patients.
CONCLUSIONS: This CPA for suspicious lung nodules in the UK NHS highlighted the potential resource savings of RAB. The final pathway influenced the model structure and highlights the need for capturing variation in pathways that occur locally. This can prompt discussions on how up-to-date current guidelines are.
METHODS: Semi-structured individual interviews were conducted in August/September 2025. Seven clinicians with experience in managing pulmonary nodules were recruited using purposive sampling. A draft care pathway, based on national guidelines, was discussed during the interviews, along with questions about variation in practice and the potential positioning/value of RAB. Thematic analysis/synthesis was undertaken, and a final care pathway diagram was produced.
RESULTS: The CPA identified important differences between clinical guidelines and clinical practice, as well as geographic variation. Although the choice of biopsy technique is influenced by nodule/patient characteristics, all clinicians agreed the availability of biopsy techniques in each centre plays a role: some use electromagnetic navigation bronchoscopy and others computed tomography-guided biopsy as first choice. All experts agreed there was potential value of RAB, including increasing biopsy eligibility for smaller, more peripheral nodules; allowing biopsy and staging in one procedure; reducing repeat scans; and allowing more confident diagnosis. Based on the pathway, a 20% increase in biopsy eligibility could reduce watch-and-wait referrals (265 to 262) and increase biopsy numbers (559 to 563) per 1,000 patients.
CONCLUSIONS: This CPA for suspicious lung nodules in the UK NHS highlighted the potential resource savings of RAB. The final pathway influenced the model structure and highlights the need for capturing variation in pathways that occur locally. This can prompt discussions on how up-to-date current guidelines are.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HSD64
Topic
Health Service Delivery & Process of Care, Medical Technologies
Disease
Oncology, Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)