Shinkins, B orcid.org/0000-0001-5350-1018, Harris, M, Lewington, A orcid.org/0000-0001-5504-0120 et al. (2 more authors) (2021) Kidney function testing prior to contrast-enhanced computed tomography: a comparative cost analysis of a personalised risk-stratified pathway vs a test all approach. Clinical Radiology, 76 (3). pp. 202-212. ISSN 0009-9260
Abstract
AIM
To map current contrast-enhanced computed tomography (CT) pathways, develop a risk-stratified pathway, and model associated costs and resource use.
MATERIALS AND METHODS
Phase 1 comprised multicentre mapping of current practice and development of an alternative pathway, replacing pre-assessment of estimated glomerular filtration rate (eGFR) with a scan-day screening questionnaire for risk stratification and point of care (PoC) creatinine. Phase 2 measured resource use and analysis of routinely collected data, used to populate a model comparing the costs of current and risk-stratified pathways in Phase 3.
RESULTS
Site variation across a range of processes within the clinical care pathway was identified. Data from a single centre suggested that 78% (n=347/447) could have avoided their pre-scan laboratory test as they did not have post-contrast acute kidney injury (AKI) risk factors. Only 24% of outpatients who underwent computed tomography (CT) would have identified risk factors, which would have prompted a scan-day PoC test. There was a 94% probability that the risk-stratified pathway was cost-saving, with an estimated 5-year potential cost saving of £69,620 (95% CI: –£13,295–£154,603). Although the cost of a laboratory serum creatinine test is cheaper than the PoC equivalent (£5.29 versus £5.96), the screening questionnaire ruled out the need for a large majority of the eGFR measurements specifically for the CT examination.
CONCLUSION
The present study proposes an alternative pathway, which has the potential to improve the efficiency of the current CT pathway. A multicentre appraisal is required to demonstrate the impact of embedding this new pathway on a wider NHS level, particularly in light of new diagnostic guidance (DG37) published by NICE.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2020 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved. This is an author produced version of an article published in Clinical Radiology. Uploaded in accordance with the publisher's self-archiving policy. |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Inst of Biomed & Clin Sciences (LIBACS) (Leeds) > Trans Anaesthetics & Surgical Sciences (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Health Sciences (Leeds) > Academic Unit of Health Economics (Leeds) |
Funding Information: | Funder Grant number NIHR National Inst Health Research Not Known Mid Yorkshire Hospital NHS Trust Not Known Leeds Teaching Hospitals NHS Trust NIHR Surgical MIC MF |
Depositing User: | Symplectic Publications |
Date Deposited: | 21 Sep 2020 13:31 |
Last Modified: | 20 Jan 2023 15:27 |
Status: | Published |
Publisher: | Elsevier |
Identification Number: | 10.1016/j.crad.2020.09.018 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:165704 |
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