Integrated care pathway for rectal cancer treatment: health care resource utilization, costs, and outcomes.
OBJECTIVE
Managed Flow C20 (MFC20) is an integrated care pathway (ICP) for rectal cancer implemented at a public teaching hospital. This study aims to quantify resource utilization and estimate direct costs and outcomes associated with the use of this ICP.


METHODS
We evaluated consecutive rectal cancer patients treated with neoadjuvant chemoradiotherapy (nCRT) followed by surgery, comparing the period before the ICP implementation (Pre-MFC20 group) and after (MFC20 group). We assessed times between treatment steps and quantified the resources utilized, as well as their costs.


RESULTS
There were 112 patients in the Pre-MFC20 group and 218 in the MFC20 group. The mean treatment intervals were significantly shorter in the MFC20 group - from the first medical consultation to nCRT (48.3 vs. 87.5 days; P < 0.001); and from nCRT to surgery (14.8 vs. 23.0 weeks; P < 0.001) - as was the mean total treatment time (192.0 vs. 290.2 days; P < 0.001). Oncology consultations, computed tomography, MRI, and radiotherapy sessions were utilized more frequently in the Pre-MFC20 group (P < 0.001). The median per-patient cost was US$11 180.92 in the Pre-MFC20 group, compared with US$10 412.88 in the MFC20 group (P = 0.125). Daily hospital charges and consultations were the major determinants of the total cost of the treatment. There was no statistical difference in overall survival in the time periods examined.
Implementation of a rectal cancer ICP reduced all treatment intervals and promoted rational utilization of oncology consultations and imaging, without increment in per-patient costs or detrimental effects in overall survival.
1Department of Radiology and Oncology, Faculdade de Medicina da Universidade de São Paulo 2Department of Radiology and Oncology, Faculdade de Medicina da Universidade de São Paulo 3Center for Translational Research in Oncology, Instituto do Câncer do Estado de São Paulo 4Department of Preventive Medicine, Faculdade de Medicina da Universidade de São Paulo 5Department of Gastroenterology, Faculdade de Medicina da Universidade de São Paulo 6Radiation Oncology Service 7Clinical Oncology Service, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil.
Silvia T
ST
Kobayashi
Maria D P E
MDPE
Diz
Alessandro G
AG
Campolina
Patricia C
PC
De Soárez
Ulysses
U
Ribeiro
Sergio C
SC
Nahas
Karina G M C
KGMC
Vasconcelos
Fernanda
F
Capareli
Ivan
I
Cecconello
Paulo M
PM
Hoff
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D019091:Critical Pathways / Q000706:statistics & numerical data*; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging / Q000191:economics* / Q000628:therapy*; D012189:Retrospective Studies; D061665:Time-to-Treatment; D016896:Treatment Outcome