Kidney function testing prior to contrast-enhanced CT: a comparative cost analysis of a personalised risk-stratified pathway versus a test all approach

•There are inefficiencies in the current CT scan pathway. •Pathway mapping demonstrates variation processes across sites. •Risk stratification and PoC creatinine testing could reduce resource use. is opportunity to unnecessary tests improve patient experience. •A risk-stratified approach may provide clinical, operational economic benefits. AIM To map contrast-enhanced computed tomography (CT) pathways, develop a pathway, model associated costs MATERIALS AND METHODS Phase 1 comprised multicentre of practice development an alternative replacing pre-assessment estimated glomerular filtration rate (eGFR) with scan-day screening questionnaire for risk point care (PoC) creatinine. 2 measured use analysis routinely collected data, used populate comparing pathways 3. RESULTS Site range within clinical pathway was identified. Data from single centre suggested that 78% (n=347/447) have avoided their pre-scan laboratory test as they did not post-contrast acute kidney injury (AKI) factors. Only 24% outpatients who underwent would identified factors, which prompted test. There 94% probability cost-saving, 5-year potential cost saving £69,620 (95% CI: –£13,295–£154,603). Although serum cheaper than equivalent (£5.29 versus £5.96), ruled out need large majority eGFR measurements specifically examination. CONCLUSION The present study proposes has efficiency A appraisal required demonstrate impact embedding this new on wider NHS level, particularly light diagnostic guidance (DG37) published by NICE.