Quality of diagnostic services for cancer: a comparison of open access and conventional outpatient clinics

Objective and study design: to assess quality of a quick and early diagnosis route (QED) by determining effectiveness and cost‐ effectiveness of five clinics compared with three conventional outpatient clinics. Prospective economic evaluation. Six‐month cohort of all referrals (November 1996‐April 1997). Subjects: all referrals for suspected cancers of: upper gastro‐intestinal tract; urinary tract, prostate and testis; skin. Effectiveness: median days saved between GP referral and date of: diagnostic appointment; consultant decision; intervention. Results: GP referral to diagnostic appointment: QED was effective (median days) for all clinics. Diagnostic appointment to consultant decision: QED was effective for testicular and haematuria clinics. Consultant decision to intervention: QED was effective for haematuria, testicular and melanoma clinics. Cost‐effectiveness: extra (incremental) NHS cost per patient diagnosed. Results: Less than £5 per day saved between GP referral and diagnostic appointment for: endoscopy; haematuria; prostate; testicular; melanoma. Less than £3 per day saved between GP referral and consultant decision for: testicular; haematuria. Less than £3 per day saved between GP referral and intervention for: endoscopy; haematuria; testicular; melanoma. Conclusion: A “quick and early” diagnostic route provides a higher quality service through improved effectiveness and cost‐effectiveness compared to conventional outpatients.