The Cost of Uncertainty: A Microcosting Analysis of the Cancer of Unknown Primary Diagnostic Pathway

BACKGROUND: Cancer of Unknown Primary (CUP) is a heterogeneous group of cancers for which a primary site cannot be identified. The diagnostic pathway is often protracted and resource-intensive, with little known about the costs involved. The primary aims of this study were to (a) determine time-to-treatment-decision (pathway duration) and (b) estimate resources incurred and direct healthcare costs within the UK's diagnostic pathway. METHODS: A microcosting analysis was conducted on 370 patients with CUP. For relevant context, a comparison cohort of 216 patients with stage IV cholangiocarcinoma (CCA) was selected. Pathways were mapped from the first cancer-related investigation until treatment decision. Analyses estimated pathway duration and cost, and explored the significance of prognostic variables on the CUP pathway. RESULTS: Median pathway duration in CUP was 40% longer than CCA (2.8 months vs 2.0 months, respectively, p < 0.001). Mean per-patient cost of the CUP pathway was 62% higher than CCA (£3902 vs £2403 respectively, p < 0.001). Performance status 0-1 and squamous-cell histology were predictive of higher costs in CUP. CONCLUSIONS: Direct healthcare costs were significantly higher in CUP. Improvements are required to rationalise investigations and facilitate patients receiving treatment in an appropriate timeframe.