Evaluating time and cost of novel colorectal cancer surveillance pathway Travel Award

Indirect costs of colorectal cancer (CRC) surveillance (e.g., waiting time) are often underdetermined. Our hospital implemented a novel "low-risk" surveillance pathway (i.e., Stage I/II CRC; low recurrence risk) to optimise patients' time-cost expenditures. This shifts routine blood tests to primary care settings close to patients' homes, paired with post-test teleconsultations. We compared patients' time-cost expenditures of this novel pathway with standard care. Kaplan and Porter's approach of time-driven activity-based costing (TDABC) application in healthcare was used. Medical condition, care delivery value chain and care process maps were defined and developed. Range estimates of time and cost, acquired through clinical observation and institutional data, were compared.
Each standard care in-person visit takes about 233.4-314.2 minutes (SGD196.06-263.93) where up to 30.0% (94.7 minutes) is waiting time. In the "low-risk" pathway, patients spend about 80.9-90.9 minutes (SGD67.96-76.36) for each primary care visit paired with teleconsultation. For every in-person visit converted to this new model, time-cost expenditure was reduced by about 28.9%.
The "low-risk" surveillance pathway showed promising time and cost savings for patients. Moving forward, TDABC should be supplemented with institutional time-cost expenditures, as well as frequency of in-person and teleconsultation visits to compute total time-cost over the five years of CRC surveillance per patient. As healthcare is patient-centered, it would also be important to examine patients' acceptability of this novel model.