JCU - Abstracts of the BAUS 2018 Scientific Meeting - June 2018 - 28

Journal of Clinical Urology 11(1S)

P2-11: Table 1

No patients attended
% Same day MRI (%)
% Same day MRI report
% patients discharged /started PSA
surveillance after single visit
No Patients biopsied (%)
Average time from referral to diagnosis
% patients referred for radical surgery
before day 38

June-November 2016

June-November 2017

143
89%
72%
28%

241
80%
80%
57%

53 (37%) - 12 same day
16 days (14 days for same day biopsy)
70%

86 (36%) - 28 same day
19 days (14 days for same day biopsy)
93%

P2-12 Significant cost savings achievable with
diagnostic pathway for prostate cancer based
on PROMIS data

Kulkarni M1, Addow A, Fernando A
1Guy's and St Thomas' Foundation Trust, London,
United Kingdom

Gill N1, Carter A1, Wilson J1
1Royal Gwent Hospital, Newport, United Kingdom

Introduction: In 2000 the government introduced an initiative to expedite the review of patients with a suspected
cancer diagnosis, termed the 'two week-wait (2WW)
pathway'. We evaluated the cancer detection rate for
patients referred via this route to our department, to
establish if this policy was still fit for purpose.
Methods: The rate of cancer detection in 9053 patients
referred as '2WW' between May 2012-May 2017 was
established. A sub-analysis of 1054 patients referred
between January 2017 -May 2017 was conducted. All
patients were evaluated in a 'one-stop' clinic, with on-theday access to phlebotomy, flexible cystoscopy, ultrasound,
CT and MRI.
Results: 9053 '2WW' patients were seen between May
2012 - May 2017. 1663 (18.4%) of these received a cancer
diagnosis. 1054 patients were seen between January - May
2017. 197 (18.6%) of these had a cancer diagnosis. Nonvisible haematuria yielded the lowest number of cancer
diagnoses at 0.18%. 362 (34%) referrals did not adhere to
the 2WW criteria, with only 20 (5.5%) of these receiving
a cancer diagnosis.
Conclusions: The 2WW pathway aims to provide a
timely review of patients with suspected malignancy. The
incidence of cancer diagnosis at our institution in the
2WW cohort is 18% overall, but lower rates are seen in
patients referred with non-visible haematuria and scrotal
lumps. Cancer detection is higher when referrals adhered
to national guidance.We recommend that BAUS conduct
a snapshot national audit of 2WW cancer diagnoses,
with subsequent review of guidelines to prevent inappropriate allocation of resources and unnecessary
patient anxiety.

Aim: Prostate biopsies are not widely enjoyed by patients
and using MRI to reduce their number would reduce septic complications and improve patient experience. Is it
cost effective? We performed an economic review of the
previous local prostate cancer diagnostic pathway of
biopsy followed by MRI imaging compared to the cost of
the current pathway using MRI prior to biopsy, in line with
PROMIS trial data.
Methods: Judgement analysis was used to produce an
outcome flow chart with probability of each pathway
branch occurring. Cost for each portion of the process
was allocated. Costings were produced by local business
intelligence unit micro analysing every step in the process,
down to time spent with receptionist, to produce an average costing. National tariff data from NHS improvement
website augmented this data.
Results: In the existing system of biopsy prior to MRI the
average cost of the diagnostic pathway was £646.70. In the
system after change, of MRI prior to prostate biopsy, the
average cost was £473.35, with a cost saving per patient of
£173.35.
Conclusion: We found that using MRI up front prior to
biopsy can be very cost effective with a relative cost reduction of 27% versus performing the MRI following biopsy.
Setting up a PROMIS trial style diagnostic pathway would be
cost effective in addition to patient experience benefits.
P2-13 Is the "two-week wait" cancer pathway
in urology fit for use, or open to abuse?

Table of Contents for the Digital Edition of JCU - Abstracts of the BAUS 2018 Scientific Meeting - June 2018