Expanding the role of radiographers in reporting suspected lung cancer: A cost-effectiveness analysis using a decision tree model

Introduction: To assess whether an enhanced role for radiographers in reporting lung cancer chest radiographs is cost-effective. Methods: Costs and outcomes of chest radiograph reporting by reporting radiographer or by a radiologist were compared using a decision tree model. The model followed patients from an initial chest radiographs for suspected lung cancer to the provision of cancer care in positive cases. Sensitivity and specificity of reporting for radiographers and radiologists were derived from a recent trial. Treatment costs and quality adjusted life expectancy were estimated over five years for those diagnosed. Deterministic and probabilistic sensitivity analyses were used to test the robustness of inference to parameter uncertainty. Results: For 1000 simulated patients, radiographer reporting decreased detection costs by £8500 and detected 10.3 more cases at initial presentation. After including treatment costs and outcomes, radiographer reporting remained cheaper than radiologist reporting and resulted in 1.4 additional QALYs per 1000 screened patients. Probabilistic analysis indicated a 98% likelihood that radiographer reporting is cheaper and more effective than radiologist reporting after inclusion of treatment costs and outcomes. Conclusion: Radiographer reporting is a cost-effective alternative to radiologist reporting in lung cancer diagnosis. Further work is needed to support the adoption of radiographer's reporting pathway in diagnosis of lung cancer suspected patients. - Highlights: • Reporting of chest radiographs for lung cancer by trained reporting radiographers is cost-effective. • Findings are robust to uncertainty in estimates of the specificity and sensitivity of radiographer and radiologist reporting. • Radiographer reporting remains cost-effective for reporting times up to fivefold more than reporting times for radiologists. • Reporting radiographers can increase diagnostic capacity within the lung cancer pathway.