OBJECTIVES

: Multi-disciplinary diagnostic centres (MDC) perform a series of diagnostic tests with the aim of providing patients with a timely and accurate diagnosis of whether they have cancer within one day. This study aimed to estimate the: 1) resource use and associated cost of the time taken to reach a diagnosis of cancer in a MDC compared with the existing two-week-wait (2WW) referral pathway in England; 2) potential for capacity constraints in the system affecting the flow of patients through the MDC pathway.

METHODS

: A discrete event simulation, assuming the healthcare system perspective, was developed to represent the referral pathways to reach a cancer diagnosis for the MDC and 2WW. The time horizon was from initial GP referral to definitive diagnosis. Expert opinion (radiologist, general practitioner, cancer programme manager) informed staffing levels and the mean time taken for each consultation and diagnostic test. Unit cost data (£; 2017) was identified using published literature. Three scenarios were developed to assess capacity constraints: 1) one extra computerised tomography (CT) scanner; 2) one extra CT scanner and required imaging staff; and 3) twenty extra patients per clinic.

RESULTS

: Estimated mean time-to-diagnosis (and associated cost) was 0.94 (0.94 to 0.95) days (£475) and 10.57 (10.54 to 10.62) days (£696) for MDC and 2WW, respectively. The number of CT scanners available and imaging staff were confirmed to be capacity constraints. When compared with the base-case scenario: scenario 1 increased overall waiting times by 2%; scenario 2 decreased waiting times by 49%; scenario 3 decreased waiting times by 31%.

CONCLUSIONS

: Indicative results suggest the MDC is able to diagnose patients faster and at lower cost compared with 2WW. Implementation of MDCs must take into account the number of CT scanners and imaging staff available to facilitate an accurate diagnosis in one day.