What is the cost of delayed diagnosis?

Different routes

HMRN's^* original research, which was funded by Blood Cancer UK and Cancer Research UK, examined and described in detail the different routes to diagnosis for people with multiple myeloma. It then looked at the impact of those routes on their survival.

This research has now been used by a team of health economists, working with Myeloma UK, to develop an economic model that estimates the present-day costs associated with each of the routes. The aim of the research is to encourage more investment in earlier diagnosis.

The five routes to diagnosis with multiple myeloma that were described in the original research are:

1. Emergency presentation – Patients referred to hospital via A&E or direct ward admission
2. GP Two Week Wait – Patients suspected of having cancer by their GP, who are referred to a hospital specialist with a maximum wait of two weeks
3. GP Urgent – Patients not suspected of having cancer by their GP but are urgently referred to a hospital specialist
4. GP Routine – Patients not suspected of having cancer by their GP, nor were they considered urgent, but were referred to a hospital specialist as routine
5. Consultant to consultant – Patients referred to a consultant by another consultant (as per NHS guidance)

Economic model

Dr Debra Howell and Professor Alex Smith, authors of the original research, have been part of the team to develop the new economic model created by Costello Medical. They are pleased to see their original work used as a building block for further research on this subject. The new research has helped to illustrate their findings and reinforce the argument for more action to improve diagnostic systems in the UK.

Detrimental and costly

The work on the economics of each route to diagnosis supports the conclusions in the original research; it shows that as well as being the most detrimental route for the patient; emergency presentation with multiple myeloma is also the most expensive route for the healthcare system.

With emergency admission the cancer is generally found at a later stage, compared to when it is discovered after a visit to a GP or a hospital consultant. This means the patient is at increased risk of complications (such as bone disease or kidney problems) and their overall health may be impaired. Currently one in three myeloma patients present through an emergency route. This is sometimes because of sudden onset of symptoms, but also worsening symptoms that could be linked to delayed diagnosis. 

Earlier diagnosis

The research recommends that myeloma should be diagnosed earlier, where possible, for both patient benefit and for reduced NHS costs. Improving the system of diagnosis might incur some extra costs, but these could be smaller than the costs of treating complications that arise from catching the disease at a later stage. With earlier diagnosis the patient’s experience and the potential outcome should be much improved.

* HMRN is the Haematological Malignancy Research Network, it is a collaborative venture with 14 regional hospitals and their diagnostic service. ECSG organises the network and performs the data management and anaylsis.