Please cite this publication as follows:Bajre, M., Pennington, M., Woznitza, N., Beardmore, C., Radhakrishnan, M., Harris, R. and Mccrone, P. (2017) Expanding the role of radiographers in reporting suspected lung cancer: a cost-effectiveness analysis using a decision tree model. Radiography, 23 (4 IntroductionTo assess whether an enhanced role for radiographers in reporting lung cancer chest radiographs is cost-effective. MethodsCosts and outcomes of chest radiograph reporting by reporting radiographer or by a radiologist were compared using a decision tree model. The model followed patients from an initial chest radiographs for suspected lung cancer to the provision of cancer care in positive cases. Sensitivity and specificity of reporting for radiographers and radiologists were derived from a recent trial. Treatment costs and quality adjusted life expectancy were estimated over five years for those diagnosed. Deterministic and probabilistic sensitivity analyses were used to test the robustness of inference to parameter uncertainty. ResultsFor 1,000 simulated patients, radiographer reporting decreased detection costs by £8,500 and detected 10.3 more cases at initial presentation. After including treatment costs and outcomes, radiographer reporting remained cheaper than radiologist reporting and resulted in 1.4 additional QALYs per 1,000 screened patients. Probabilistic analysis indicated a 98% likelihood that radiographer reporting is cheaper and more effective than radiologist reporting after inclusion of treatment costs and outcomes. ConclusionRadiographer reporting is a cost-effective alternative to radiologist reporting in lung cancer diagnosis. Further work is needed to support the adoption of radiographer's reporting pathway in diagnosis of lung cancer suspected patients.Word count -2483

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Objectives: To determine short-term financial consequences of the use of mepolizumab in severe eosinophilic asthma (SEA) versus omalizumab and reslizumab where the comparison is reliable. Methods: Assessment of clinical outcomes was based on published meta-analyses. Cost-minimization and budget impact analyses were performed from healthcare perspective and one year time horizon. Targeted populations included adult severe eosinophilic asthma patients with elevated IgE level, and weight ranged 66,6-100 kg. We collated only annual drug costs. Dosages were derived from the labels. We used prices data from different sources (incl. tender-auction, retail and registered prices). Exchange rate: V1 = 73,26 rubles (as of 10/06/2019; available at www.cbr.ru). Deterministic one-way sensitivity analysis was performed. Results: Based on meta-analyses (Cockle 2016, Henriksen 2018) we assumed the same efficacy and safety. Annual treatment cost of mepolizumab, reslizumab, and omalizumab were V11425, V13461, and V22043, respectively. Therefore, budget savings when using mepolizumab amounted to V2036 versus reslizumab, and V10618 versus omalizumab per patient per year. Results can be sensitive to price fluctuations. Once the price landscape will change the results should be recalculated. Conclusions: Mepolizumab can be cost-saving alternative versus reslizumab and omalizumab in the specified population of eligible patients with severe eosinophilic asthma.

BackgroundAutoimmune hepatitis (AIH) is a rare chronic progressive liver disease, managed with corticosteroids and immunosuppressants and monitored using a combination of liver biochemistry and histology. Liver biopsy (gold standard) is invasive, costly and has risk of complications. Non-invasive imaging using multiparametric magnetic resonance (mpMR) can detect the presence and extent of hepatic fibroinflammation in a risk-free manner.ObjectiveTo conduct early economic modelling to assess the affordability of using mpMR as an alternative to liver biopsy.MethodsMedical test costs associated with following 100 patients over a 5-year time horizon were assessed from a National Health Service payor perspective using tariff costs and average biopsy-related adverse events costs. Sensitivity analyses modelling the cost consequences of increasing the frequency of mpMR monitoring within the fixed cost of liver biopsy were performed.ResultsPer 100 moderate/severe AIH patients receiving an annual mpMR scan (in place of biopsy), early economic modelling showed minimum cost savings of £232 333. Per 100 mild/moderate AIH patients receiving three mpMR scans over 5 years estimated minimum cost savings were £139 400. One-way sensitivity analyses showed increasing the frequency of mpMR scans from 5 to 10 over 5 years in moderate/severe AIH patients results in a cost saving of £121 926.20. In patients with mild/moderate AIH, an increase from 3 to 6 mpMR scans over 5 years could save £73 155.72. In a minimalistic approach, the use of 5 mpMR scans was still cost saving (£5770.48) if they were to replace two biopsies over the 5-year period for all patients with moderate/severe or mild/moderate AIH.ConclusionsIntegration of mpMR scans in AIH patient pathways leads to significant cost savings when liver biopsy frequency is either reduced or eliminated, in addition to improved patient experience and clinician acceptability as well as providing detailed phenotyping to improve patient outcomes.Trial registrationNCT03979053.

Background: The objective of this study was to undertake an early economic evaluation to analyse the potential costs and benefits associated with adopting a high sensitivity troponin (hs-cTn) at the Point of Care (POC) in the emergency department (ED) diagnostic pathway for suspected Acute Coronary Syndrome (ACS) patients in line with National Institute for Health and Care Excellence (NICE) Diagnostics Guidance (DG15) and NICE Clinical Guideline (CG95) as practised in the NHS in England. Methods: A decision tree analysis was undertaken to compare the current 60 to 90 minutes turnaround time for the standard laboratory hs-cTn test with an expected 20-minute turnaround time for a POC hs-cTn test. Three routes through the chest pain pathway were modelled based on the hs-cTn pathway used in Oxford University Hospitals (OUH) NHS Foundation Trust. Sensitivity analysis was performed. Results: The results indicate that if a hs-cTn POC test is used to diagnose patients in routes 1 to 3 of the diagnostic pathway for suspected ACS patients at ED, it potentially saves per patient costs of £53.36 in Route 1, £76.72 in Route 2 and £64.72 in Route 3. Moreover, it can also help in easing the pressure at ED as it enables diagnosis to be made between 55 to 70 minutes earlier across the 3 pathway routes. A hs-cTn POC test also has potential in achieving a ‘rule-in’ diagnosis for patients to speed up the treatment pathway for improved prognosis. The sensitivity analysis results indicate that savings per patient increase as the turnaround time of the lab result goes from 60 minutes to 90 minutes in the standard care pathway.Conclusions: Use of a hs-cTn test at POC can save between £53.36 and £76.72 per patient in ED when compared to the standard laboratory test. When such a POC test is developed, an evaluation validating the accuracy of the device will be needed together with a study of its clinical performance in a health care setting. The study should include a formal economic evaluation with real-world data alongside an efficacy/effectiveness study.