Background/Purpose:   With incidence of 2.2 per 10,000 patient years, it is estimated that 12,000 new cases of Giant Cell Arteritis (GCA) are diagnosed every year in the UK of whom 20% lose sight permanently. This has significant implications on personal, social care and socioeconomic costs. A fast-track GCA pathway was introduced in 2012 aimed at reducing multiple referral routes, delayed review and treatment and improving outcomes. We report the cost effectiveness of this pathway.

 Methods: A retrospective data analysis of 138 patients investigated for GCA (Jan 2009-Dec 2012), comparing costs of fast-track pathway (57 patients; Jan – Dec 2012) with the conventional referral route (81 patients; pre 2012) using the incremental cost effectiveness ratio (ICER).  Data was collected from patient records, general practice and pathology databases along with telephone questionnaires. Direct costs included: GP appointments, investigations such as blood tests, scans and biopsies, outpatient appointments (Rheumatology, Eye Clinic and Neurology), A&E attendances, Inpatient stays, readmissions, drugs for treatment of GCA. Costing data for treatment and diagnosis costs was gathered from Reference Costs 2011/12, Prescription Cost Analysis 2012, and Unit Costs of Health and Social Care 2012. QOL was measured in 66 patients using the EQ5D. Health gains from diagnosis and treatment of GCA were quantified using Quality Adjusted Life Years (QALY’s).

Results: The fast-track pathway has seen a reduction in number of GP appointments and cost of diagnosis and treatment.  The difference in QALYs between patients with and without sight loss due to GCA was 0.2. Each patient that didn’t lose vision gained on average 2.6 QALY’s.  The average cost of diagnosing and treating a patient with suspected GCA in the conventional pathway was £2,600, whilst in the fast-track; this was £1,675, a difference of £925 per patient.  The ICER of implementing the fast-track pathway is –£1,950 per QALY. Thus, there is an average cost saving to the NHS of £925 for each patient treated for suspected GCA.

Table1 Patients with sight loss and the costs of treatment/diagnosis in the conventional and fast-track pathway

Conclusion: The fact-track pathway leads to a reduction in irreversible sight loss and is associated with reduced diagnosis and treatment costs. It results in 2.6 QALY’s gained for each patient that does not suffer sight loss, suggesting that the fast-track pathway is more cost effective than the conventional pathway for management of early GCA. The ICER of implementing the fast-track pathway is –£1,950 per QALY with an average cost saving to the NHS of £925 for each patient. Our results do not include the small educational/refresher costs and are preliminary but indicate that the Fast track GCA pathway should be ‘rolled out’ globally.