title: Are multidisciplinary teams in secondary care cost-effective? A systematic review of the literature.
abstract: OBJECTIVE
  To investigate the cost effectiveness of management of patients within the context of a multidisciplinary team (MDT) meeting in cancer and non-cancer teams in secondary care.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  EMBASE, MEDLINE, NHS EED, CINAHL, EconLit, Cochrane Library, and NHS HMIC.
  
  
  METHODS
  Randomised controlled trials (RCTs), cohort, case-control, before and after and cross-sectional study designs including an economic evaluation of management decisions made in any disease in secondary care within the context of an MDT meeting.
  
  
  METHODS
  Two independent reviewers extracted data and assessed methodological quality using the Consensus on Health Economic Criteria (CHEC-list). MDTs were defined by evidence of two characteristics: decision making requiring a minimum of two disciplines; and regular meetings to discuss diagnosis, treatment and/or patient management, occurring at a physical location or by teleconferencing. Studies that reported on the costs of administering, preparing for, and attending MDT meetings and/or the subsequent direct medical costs of care, non-medical costs, or indirect costs, and any health outcomes that were relevant to the disease being investigated were included and classified as cancer or non-cancer MDTs.
  
  
  RESULTS
  Fifteen studies (11 RCTs in non-cancer care, 2 cohort studies in cancer and non-cancer care, and 2 before and after studies in cancer and non cancer care) were identified, all with a high risk of bias. Twelve papers reported the frequency of meetings which varied from daily to three monthly and all reported the number of disciplines included (mean 5, range 2 to 9). The results from all studies showed mixed effects; a high degree of heterogeneity prevented a meta-analysis of findings; and none of the studies reported how the potential savings of MDT working may offset the costs of administering, preparing for, and attending MDT meetings.
  
  
  CONCLUSIONS
  Current evidence is insufficient to determine whether MDT working is cost-effective or not in secondary care. Further studies aimed at understanding the key aspects of MDT working that lead to cost-effective cancer and non-cancer care are required.
authors.affiliation: School of Oral and Dental Sciences, University of Bristol, Lower Maudlin Street, Bristol BS1 2LY, UK. Melissa.Ke@bristol.ac.uk.
authors.forename: K Melissa
authors.initials: KM
authors.lastname: Ke
authors.forename: Jane M
authors.initials: JM
authors.lastname: Blazeby
authors.forename: Sean
authors.initials: S
authors.lastname: Strong
authors.forename: Fran E
authors.initials: FE
authors.lastname: Carroll
authors.forename: Andy R
authors.initials: AR
authors.lastname: Ness
authors.forename: William
authors.initials: W
authors.lastname: Hollingworth
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