Table 6

Estimated effects on hospital and the funding primary care trust (PCT) costs assuming a service with 300 cases per annum

Model 1Model 2Model 3
No. of patients300300300
Financial impact on hospital
Cost to hospital per patient (£)246528912833
Income via HRG per FCE (£)254925492549
Income: cost per patient (£)84−372−284
Financial impact on PCT
Total cost to hospital (£)300×2465=739 500300×2891=867 300300×2833=849 900
Total cost to PCT (£)300×2549=764 700(300+84)×2549=978 816300×2549=764 700
Income: cost to hospital (£)25 200111 516−85 200
  • Model 1, wide local excision (WLE) with axillary clearance; Model 2, WLE with sentinal lymph node biopsy (SLNB) and later immunohistochemistry; Model 3, WLE with SLNB assessed by Genesearch assay.

  • Completion refers to the 28% of patients with a positive sentinal lymph nodes (SLNs) who require completion axillary dissection, leading to an extra 84 procedures in model 2 and 84 patients in model 3 receiving immediate axillary clearance. The income to the hospital trust is calculated from the cost allocated to the relevant health resource group (HRG) per finished consultant episode (FCE) applicable within the UK National Health Service (NHS).

  • In calculating these costs, the following assumptions and charges have been included: (i) the surgeon and anaesthetist NHS costs are based on average salary against chargeable programmed activities (PAs), (ii) this does not include hotel costs and is based on July 2008 bed days and expenditure as at month 12 July 2008; (iii) theatre staff costs are based on 4:2 trained to untrained, equating to £525 per session or £2.49 per minute based on 210 min sessions; (iv) theatre stock expenditure calculated from total expenditure and number of procedures to give a £62 basic cost per procedure, which was then weighted by a consumable consumption factor 0.5–1.5 depending upon the procedure; (v) theatre overheads includes the cost of domestics, security, maintenance, management, etc; (vi) multidisciplinary team meeting, assumed nine consultants, one consultant nurse, three nurses, 2 administrative assistants (A&C); (vii) total cost of clinical support and facilities management equates to 36% of the direct costs; (viii) includes of cost of buildings, human resources, finance, ICT, planning, etc., 15.6% of tariff income tariff based on HRG (J11).