Improving outcomes for people with skin tumours including melanoma

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Improving Outcomes for People with Skin Tumours including Melanoma Appendix 3 Appendix 3 Economic implications of the guidance A3 Executive summary A summary of the economic consequences of the recommendations of the Guidance on Cancer Services: Improving outcomes for people with skin tumours including melanoma in England and Wales are set out in this section. The analysis focuses on those aspects of the key recommendations that are likely to be of greatest consequence in terms of cost, the most significant of which will be in respect of additional staffing. There is uncertainty around the estimates presented and there will be variation between cancer networks. Sensitivity analyses were conducted to account for uncertainty in the estimated costs. Further assessments will be needed at cancer network level and/or NHS trust level to determine the exact cost implications. Work is currently being carried out in the NHS in England, in connection with Payment by Results, to develop a better understanding of costs of treatment and care, and this may help these assessments in the future. The summary of the economic implications is outlined in two tables. Table A1 presents service delivery options regarding clinicians working in the community and for multidisciplinary team (MDT) working, the resource implications of which will be dependent upon the level of existing services. Table A2 presents additional resource implications that apply across cancer networks. 136 National Institute for Health and Clinical Excellence
Table A1. Summary of service options and annual resource implications for cancer networks Estimate (£) Range (£) Community Service cost, inclusive 625,727 469,296 782,159 clinicians of staff time and consumables Improving Outcomes for People with Skin Tumours including Melanoma Appendix 3 GPwSI sessional rate 329,373 247,030 411,716 Hospital practitioner 196,773 147,580 245,966 sessional rate MDT For cancer networks 129,134 96,851 161,418 with no MDTs, moving to low MDT provision For cancer networks 258,268 193,701 322,835 with no MDTs, moving to high provision A3 For cancer networks 49,888 37,416 62,360 with partial MDTs, moving to low provision For cancer networks 105,662 79,246 132,077 with partial MDTs, moving to high provision Table A2. Summary of annual cancer network level resource implications Range 1 (£) Additional staff MDT coordinators 44,470 88,941 Skin cancer clinical nurse specialists (CNS) 142,330 177,913 Consultants 555,284 555,284 Sub-total 742,085 822,138 Special groups 2 Transplant patients 4,370 17,480 Cancer registries Set-up costs 3 963 1,482 Recurring costs 963 1,482 Total (range) 747,418 841,101 1 Costs reflect low and high staffing requirement, rounded to the nearest £. 2 Assuming one clinic per cancer network. 3 One-off cost and not added into annual total. Guidance on cancer services: skin tumours including melanoma 137
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NHS National Institute for Health a
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Contents Improving Outcomes for Peo
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Patient information ...............
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Resource implications .............
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Foreword Improving Outcomes for Peo
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- referral - review of patient care
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early detection have been published
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The epidemiology of skin cancers an
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The incidence of MM increases with
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Figure 5. Mortality from MM, Englan
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Figure 8. Incidence of NMSC, Englan
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Risk factors for skin cancer As ski
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Figure 12. Rates of episodes of inp
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Two-week wait data Urgent skin canc
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• Improving the experience of car
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12. National Institute for Clinical
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Patient-centred care Improving Outc
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This document and the NICE Referral
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A checklist may be used by healthca
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Quality assurance Surveys of patien
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One cross-sectional study found tha
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One RCT conducted with patients wit
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• Every skin cancer MDT having ac
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to estimate a separate cost for ser
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department or they may be referred
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The 2-week waiting time standard an
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The local hospital skin cancer mult
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A function of the LSMDT is to audit
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• lymphoedema therapists • phar
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SSMDT meetings should be at least f
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As set out in the section on ‘Arr
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• Palliative care specialists. Si
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Videoconferencing and teleconferenc
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A basic knowledge of skin cancer hi
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B. Anticipated benefits At present,
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One systematic review (of the abili
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One retrospective study compared pa
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• Critical incidents where treatm
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Network-wide protocols It is not po
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Initial investigation, diagnosis, s
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Figure 14. Skin lesion - patient pa
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curettage (as recommended in BAD gu
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Diclofenac 3% gel (Solaraze) is lic
Page 87 and 88: Histopathology services for skin ca
Page 89 and 90: Patients with anogenital Bowen’s
Page 91 and 92: B. Anticipated benefits Better-qual
Page 93 and 94: One RCT compared teledermatology wi
Page 95 and 96: One systematic review based upon 12
Page 97 and 98: Expert review evidence suggests tha
Page 99 and 100: Immunotherapy An RCT comparing allo
Page 101 and 102: • Adherence to treatment protocol
Page 103 and 104: F. Research priorities • Given th
Page 105 and 106: For patients with low-risk BCC or S
Page 107 and 108: Follow-up for patients after treatm
Page 109 and 110: C. Evidence Evidence exists that ea
Page 111 and 112: One observational study found that
Page 113 and 114: The written and photographic inform
Page 115 and 116: Genetic predisposition to MM may al
Page 117 and 118: patients with cutaneous lymphoma sh
Page 119 and 120: A. Recommendations Generic recommen
Page 121 and 122: Cutaneous lymphoma All patients sho
Page 123 and 124: Children and young people with skin
Page 125 and 126: Gorlin’s syndrome Two expert revi
Page 127 and 128: Process • Audit of adherence to p
Page 129 and 130: • Cutaneous lymphoma is so rare t
Page 131 and 132: Dermal and subcutaneous tumours Aty
Page 133 and 134: c) The guidance will also refer to
Page 135 and 136: 4.2.2 Healthcare settings and servi
Page 137: Referral from the Department of Hea
Page 141 and 142: For those cancer networks with part
Page 143 and 144: Appendix 4 How this guidance manual
Page 145 and 146: Appendix 5 People and organisations
Page 147 and 148: Professor Julia Newton-Bishop Mr Ba
Page 149 and 150: • Bristol South and West PCT •
Page 151 and 152: • Healthcare Commission • Help
Page 153 and 154: • Royal College of Surgeons of En
Page 155 and 156: Appendix 5.3 Researchers carrying o
Page 157 and 158: Appendix 5.4 Expert advisers to the
Page 159 and 160: Appendix 5.5 Report* commissioned t
Page 161 and 162: Appendix 6 Glossary of terms Improv
Page 163 and 164: Chemoprophylaxis The use of a drug
Page 165 and 166: Electrodesiccation A surgical metho
Page 167 and 168: Immunotherapy Treatment by stimulat
Page 169 and 170: Morbidity A diseased condition or s
Page 171 and 172: Prognosis A prediction of the likel
Page 173 and 174: Systemic therapy Treatment that rea
Page 175 and 176: KS LHB LSMDT MCC MDT MM MRI NCC-C N
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Improving outcomes for people with skin tumours including melanoma

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