P287 The upper GI TWW pathway: value for money?

IntroductionThe UGI TWW pathway provides GPs with rapid access to diagnostics for patients with symptoms possibly due to oesophageal/gastric cancer. In 2010 we reported the cancer detection rate (CDR) and cost-effectiveness of the pathway (Atchua Gut 2010). This study aims to re-assess the CDR and costs of the pathway given the potential for delayed cancer presentation and new ways of working (eg telephone consultation, dysphagia scores) following the COVID pandemic.MethodsAn observational cohort study of patients referred to a single hospital service serving an inner London population of 420,000. Inclusion criteria: all UGI TWW referrals. Exclusion criteria: routine outpatient referrals, A&E presentations, or tertiary referrals diagnosed elsewhere. Linked hospital databases (radiology, endoscopy and pathology) were searched with unique patient identifiers to capture activity. Patients with dysphagia were initially triaged (based on the Edinburgh Dysphagia score) to barium swallow or endoscopy during a nurse led telephone clinic, whilst the remainder were all assessed in clinic. NHS tariff (2022) costs for diagnostics and clinic visits were used to calculate overall resource use up until cancer was diagnosed or ruled out.ResultsFrom 1/1/21–30/11/22 692 patients (63% female) median age 61 yr range (18–102 yrs) entered the pathway. Dysphagia (44%), weight loss (26%), and dyspepsia (22%) were the main presenting complaints. Twelve patients were found to have cancer (oesophageal n=6, gastric n = 2, Liver/pancreas n=2 & other n=6, overall CDR=2.3%). Gastritis (19%) hiatus hernia (16%) and GORD (8%) were the principal non-cancer diagnoses. Table 1) which was associated with a 74% increase in total cost of the pathway. However the costs of diagnosing each cancer fell, compared to ‘ruling-out’ cancer which increased (table 1), due to increased use of imaging and less EUS/ERCP.Abstract P287 Table 1 2010 n (%) 2022 n (%) Cohort size 515 692 Female% 288 (56) 435 (63) p < 0.05 Cancers found 34 (6.6) 16 (2.3) p < 0.05 OGD 429 (83) 555 (80) Colonoscopy 61 (12) 76 (11) USS 69 (13) 47 (7) p < 0.05 Ba Swallow 9 (2) 59 (9) p < 0.05 CT + MRI 112 (22) 216 (31) p < 0.05 EUS + ERCP 42 (8) 6 (1) p < 0.05 Total Costcost per patient - cancerno-cancer £261k £1132 £567 £454k £896 £646 ConclusionsThe UGI TWW pathway CDR has fallen, as has the costs associated with those patients rarely found to have cancer. However the costs incurred with ruling out cancer have risen despite new work