Cost effectiveness analysis of the financial impact and efficiency of a same day prostate cancer assessment and diagnostic clinic in the Australian public health system

Introduction and Objectives: The ‘One Stop Prostate Clinic’ (OSPC) was a Consultant led same day rapid access prostate cancer assessment and diagnostic clinic at a public tertiary hospital in Western Australia. The actual OSPC was a hybrid clinic of de-novo referrals and men with prior urological assessment. The impact of the OSPC, including cost savings, clinic appointment (for rural and metro men) and travel savings (for rural men) arising from the OSPC in comparison to a Usual Care Pathway (UCP) are reported. Methods: Prospective data collection between August 2011 and November 2017 of referral, attendance and follow for men attending the OSPC (actual). Journey mapping identified time from referral to diagnosis, outpatient clinic appointment and travel savings. Comparison of cost effectiveness of all episode of care costs between the OSPC (assuming 100% theoretical de-novo referrals) and a Usual Care Pathway (UCP) (assuming 100% de-novo referrals), including the impact on the Patient Assisted Transport Scheme (PATS) for rural men. Results: 1,000 men attended between August 2011 and November 2017. 466 (47%) men were rural and 534 (53%) men were metro. 876 (420 (48%) rural and 456 (52%) metro) men underwent prostate biopsy and 800 (359 (45%) rural and 441 (55%) metro) men attended a follow up outpatient appointment (OPA). The actual OSPC pathway saved 543 travel episodes (distance of 1.5 million kilometres) and 658 OPA’s (357 rural men and 301 metro men) for those men who underwent biopsies. 173 (95 (55%) rural and 78 (45%) metro) men were discharged to their GP. 24 (9 (37%) rural and 15 (63%) metro) men were discharged to private urology follow up. Follow up was unable to be arranged for 3 men. Total episode of care costs for the OSPC pathway (assuming 100% de-novo referral) were estimated to be $2,237.34, compared to$2,847.00 for a UCP (assuming 100% de-novo referral), generating savings of $609.66 per attendance and$609,658.22 overall for 1,000 men. Mean time from referral to diagnosis was 60 days (rural 57 days and metro 63 days, p = 0.034). Conclusion: The OSPC was more cost effective and efficient in comparison to a UCP with its streamlined single contact assessment and diagnostic pathway. Significant financial, outpatient appointment for all men and travel savings (number of episodes and distances travelled) for rural men were generated through the OSPC.No Full Tex

Anterior pelvic exenteration and synchronous bilateral nephroureterectomy for BK polyoma virus induced urothelial carcinoma of the bladder: A case report

BK polyoma virus (BKV) is a known risk factor for the development of urothelial carcinoma. There is currently limited data on the management of BKV-induced urothelial carcinoma (BUC) of the bladder, with available data limited to case reports. It remains debatable whether radical cystectomy (RC) with removal of the native urinary tract or RC alone is the most optimal management for BUC of the bladder. BKV-induced urothelial carcinoma is rare, and its management is challenging in immunocompromised patients such as that of post-transplant patients. This case report provides additional insight into a rare disease, the management of which still lacks established guidelines and remains debatable. We present a unique case of BKV-induced muscle-invasive urothelial carcinoma of the bladder in an immunosuppressed renal transplant patient who underwent open radical cystectomy, anterior pelvic exenteration, bilateral native nephroureterectomy and ileal conduit formation to transplant kidney. The patient remains recurrence-free with preserved graft function 2 years since surgery. An aggressive management approach which involves anterior pelvic exenteration with removal of the native urinary tract may be favoured in young patients with BUC of the bladder with minimal comorbidities. However, treatment should be individualised for each individual patient.</jats:p

Anterior pelvic exenteration and synchronous bilateral nephroureterectomy for BK polyoma virus induced urothelial carcinoma of the bladder: A case report

BK polyoma virus (BKV) is a known risk factor for the development of urothelial carcinoma. There is currently limited data on the management of BKV-induced urothelial carcinoma (BUC) of the bladder, with available data limited to case reports. It remains debatable whether radical cystectomy (RC) with removal of the native urinary tract or RC alone is the most optimal management for BUC of the bladder. BKV-induced urothelial carcinoma is rare, and its management is challenging in immunocompromised patients such as that of post-transplant patients. This case report provides additional insight into a rare disease, the management of which still lacks established guidelines and remains debatable. We present a unique case of BKV-induced muscle-invasive urothelial carcinoma of the bladder in an immunosuppressed renal transplant patient who underwent open radical cystectomy, anterior pelvic exenteration, bilateral native nephroureterectomy and ileal conduit formation to transplant kidney. The patient remains recurrence-free with preserved graft function 2 years since surgery. An aggressive management approach which involves anterior pelvic exenteration with removal of the native urinary tract may be favoured in young patients with BUC of the bladder with minimal comorbidities. However, treatment should be individualised for each individual patient

Abstract LB036: Clinical value of 18F-FDG-PET compared with CT scan in the detection of nodal and distant metastasis in urothelial carcinoma or bladder cancer

Abstract Computed tomography (CT) scan is the standard imaging modality for staging patients with urothelial carcinoma (UC) or bladder cancer (BC). Despite negative staging prior to surgery, 20-30% of patients have lymph node (LN) metastasis. Surgery for BC and UC has high morbidity and preoperative staging is vital. Value of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) in staging UC and BC is debatable. We report a large series comparing 18F-FDG-PET with CT. We retrospectively reviewed 90 patients diagnosed with UC or BC who underwent surgery or confirmatory biopsy that were staged with both CT and 18F-FDG-PET between 2015 and 2020. 78 patients staged with CT and 18F-FDG-PET had formal pelvic LN dissection. 21 patients had neoadjuvant chemotherapy (NAC). 18F-FDG-PET reports for positive sites were qualitative, with 18F-FDG avid sites considered positive. On CT, enlarged LN by RECIST criteria 1.1 (&amp;gt;10 mm) and other qualitative findings suggesting metastasis were considered positive. Histopathological findings from surgical specimens or image guided biopsy were considered gold standard in comparison to imaging reports. 18F-FDG-avid or enlarged pelvic LNs with surgically proven nodal metastasis were considered true positives. Performance characteristics of 18F-FDG-PET and CT including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (PPV) were calculated. Metastatic pelvic LN were confirmed histologically in 18/78 (23.1%) patients. Sensitivity, specificity, PPV and NPV of CT for detecting pelvic LN metastases were 27.8% (95% CI:10.7-53.6%), 96.7% (95% CI:87.5-99.4%), 71.4% (95% CI:30.3-94.9%) and 81.7% (95% CI:70.4-89.5%) respectively. Sensitivity, specificity, PPV and NPV of 18F-FDG-PET for detecting pelvic LN metastases were 50.0% (95% CI:26.8-73.2%), 88.3% (95% CI:76.8-94.8%), 56.3% (95% CI:30.6-79.2%) and 85.5% (95% CI:73.7-92.7%) respectively. 11/90 (12.2%) patients had 18F-FDG-PET suggestive of distant metastases. 10 (90.9%) of these 11 patients had image guided biopsy of these 18F-FDG-PET-positive sites confirming metastases. Pre-operative staging with 18F-FDG-PET identified metastatic disease in 4/85 (4.7%) patients which were occult on CT. This retrospective study suggested that 18F-FDG-PET may be more sensitive than CT for detecting pelvic LN metastases. 4/85 (4.7%) patients avoided cystectomy due to 18F-FDG-PET diagnosed metastases which were not reported on CT. Further research involving randomised controlled trials comparing the diagnostic yield of 18F-FDG-PET and CT in detecting nodal and distant metastasis in UC or BC is warranted to confirm our findings. Citation Format: Oliver Oey, Pravin Viswambaram, Jeremy Ong, Richard Gauci, Ronny Low, Dickon Hayne. Clinical value of 18F-FDG-PET compared with CT scan in the detection of nodal and distant metastasis in urothelial carcinoma or bladder cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr LB036.</jats:p

Analysis of the financial impact and efficiency of the One Stop Prostate Clinic: A same day prostate cancer diagnostic clinic in the Australian public health system

Background: Access to prostate cancer diagnostic clinics are challenging for rural men in Western Australia due to remoteness and long travel distances. The One Stop Prostate Clinic (OSPC) provided same day assessment and diagnosis for prostate cancer in a public tertiary hospital to reduce access barriers for rural men. The objective of this study was to determine the financial and resource utilisation impact of the OSPC compared to a usual care pathway (UCP). Design and methods: Study design: Cost minimisation analysis of the OSPC model (assuming 100% new referrals) compared with a UCP, including impact on the Patient Assisted Transport Scheme (PATS) for rural men. An estimate of total cost comparison of OSPC and UCP pathways of outpatient and diagnostic costs was calculated based on journey mapping of attendance and follow up. Methods: Prospective data collection between August 2011 and November 2017 of referral, attendance and follow up outcomes. Journey mapping to identify time from referral to diagnosis, number of outpatient appointment (OPA) and travel savings. Results: A total of 1000 men attended – 466 (47%) rural and 534 (53%) metro. Mean time from referral to diagnosis was 57 days (rural) versus 63 (metro; p = 0.034)). The OSPC saved 543 travel episodes (distance of 1.5M km) and 658 OPA’s. Total episode of care costs for the OSPC (100% new) pathway estimated as $2237.34, compared to$2847.00 for a UCP, generating savings of $609.66 per attendance ($609,658.22 overall). Conclusion: The OSPC was more cost effective and efficient in comparison to a UCP.Full Tex

Nurse-led telephone notification of a prostate cancer diagnosis: Prospective analysis of men's preferences for and experiences of a same-day assessment and diagnostic clinic

Objective The ‘One Stop Prostate Clinic’ (OSPC) was a same-day prostate cancer assessment and/or diagnostic clinic. Preferences and experiences of men who received initial telephone notification of their prostate biopsy results (cancer or benign) by the OSPC Clinical Nurse (CN) are reported. Methods Prospective mixed methods study using survey instrument and thematic analysis of OSPC preferences and experiences. Results One thousand men attended the OSPC between August 2011 and November 2017, 876 underwent prostate biopsies; 790/876 (90%) men consented to telephone notification of biopsy results, 5/876 (1%) declined and 79/876 (9%) were ineligible/not contacted. 220/403 men (55%) returned the OSPC questionnaire; 135/220 (61%) men received a cancer diagnosis, 119/132 (90%) would choose this method again and 7/132 (5.5%) would not and 6/132 (4.5%) were unsure; 94/135 (70%) reported no disadvantages with this notification method. Overall satisfaction rate with the OSPC was 96% (209/218) men. Conclusion Initial telephone notification of prostate biopsy results by the OSPC CN was preferred by the vast majority of eligible men. Many men with a cancer diagnosis did not experience any disadvantages. This method of results delivery can be incorporated by other tumour groups

Analysis of the financial impact and efficiency of the One Stop Prostate Clinic: A same day prostate cancer diagnostic clinic in the Australian public health system

Background: Access to prostate cancer diagnostic clinics are challenging for rural men in Western Australia due to remoteness and long travel distances. The One Stop Prostate Clinic (OSPC) provided same day assessment and diagnosis for prostate cancer in a public tertiary hospital to reduce access barriers for rural men. The objective of this study was to determine the financial and resource utilisation impact of the OSPC compared to a usual care pathway (UCP). Design and methods: Study design: Cost minimisation analysis of the OSPC model (assuming 100% new referrals) compared with a UCP, including impact on the Patient Assisted Transport Scheme (PATS) for rural men. An estimate of total cost comparison of OSPC and UCP pathways of outpatient and diagnostic costs was calculated based on journey mapping of attendance and follow up. Methods: Prospective data collection between August 2011 and November 2017 of referral, attendance and follow up outcomes. Journey mapping to identify time from referral to diagnosis, number of outpatient appointment (OPA) and travel savings. Results: A total of 1000 men attended – 466 (47%) rural and 534 (53%) metro. Mean time from referral to diagnosis was 57 days (rural) versus 63 (metro; p = 0.034)). The OSPC saved 543 travel episodes (distance of 1.5M km) and 658 OPA’s. Total episode of care costs for the OSPC (100% new) pathway estimated as $2237.34, compared to$2847.00 for a UCP, generating savings of $609.66 per attendance ($609,658.22 overall). Conclusion: The OSPC was more cost effective and efficient in comparison to a UCP. </jats:sec