Revising the suspected-cancer guidelines: Impacts on patients’ primary care contacts and costs
Price, S; Landa, P; Mujica-Mota, R; et al.Hamilton, W; Spencer, A
Date: 8 August 2022
Article
Journal
Value in Health
Publisher
Elsevier
Publisher DOI
Abstract
Objectives: Exploring the impact of revising suspected-cancer referral guidelines on primary
care contacts and costs.
Methods: Participants had incident cancer (colorectal: n=2,000; ovary: n=763; pancreas: n=597)
codes in the Clinical Practice Research Datalink or England cancer registry. Difference-indifferences analyses explored ...
Objectives: Exploring the impact of revising suspected-cancer referral guidelines on primary
care contacts and costs.
Methods: Participants had incident cancer (colorectal: n=2,000; ovary: n=763; pancreas: n=597)
codes in the Clinical Practice Research Datalink or England cancer registry. Difference-indifferences analyses explored guideline impacts on contact days and non-zero costs between the
first cancer feature and diagnosis. Participants were controls (“Old-NICE”), or “New-NICE” if
their index feature was introduced during guideline revision. Model assumptions were inspected
visually and by falsification tests. Sensitivity analyses re-classified participants who
subsequently presented with feature(s) in the original guidelines as “Old-NICE”. For colorectal
cancer, sensitivity analysis (n=3,481) adjusted for multimorbidity burden.
Results: Median (interquartile range) contact days and costs were: 4 (2–7) and £117.69 (£53.23-
£206.65) for colorectal; 5 (3-9) and £156.92 (£78.46-£272.29) for ovary, and 7 (4-13) and
£230.64 (£120.78-£408.34) for pancreas. Revising ovary guidelines may have decreased contact
days (incidence rate ratio 0.74, 95%CI 0.55-1.00, p=0.05) with unchanged costs, but parallel
trends assumptions were violated. Costs decreased by 13% (equivalent to -£28.05, -£50.43 to -
£5.67) after colorectal guidance revision, but only in sensitivity analyses adjusting for
multimorbidity. Contact days and costs remained unchanged after pancreas guidance revision.
Conclusions: The main analyses of symptomatic patients suggested that pre-diagnosis primary
care costs remained unchanged after guidance revision for pancreatic cancer. For colorectal
cancer, contact days and costs decreased in analyses adjusting for multimorbidity. Revising
ovarian cancer guidelines may have decreased primary care contact days but not costs,
suggesting increased resource-use intensity; however, there is evidence of confounding.
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