Costs and benefits of a one stop clinic compared with a dedicated breast clinic: randomised controlled trial * Commentary: one stop clinics should not be abandoned

doi:10.1136/bmj.324.7336.507

BMJ 2002;324:507 ( 2 March )

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Costs and benefits of a one stop clinic compared with a dedicated breast clinic: randomised controlled trial

Paola Dey, lecturer, ^a Nigel Bundred, professor, ^b Alan Gibbs, statistician, ^a Penny Hopwood, senior research fellow, ^d Andrew Baildam, consultant surgeon, ^b Caroline Boggis, consultant radiologist, ^b Marilyn James, senior lecturer, ^c Fiona Knox, consultant pathologist, ^b Vicki Leidecker, research associate, ^a Ciarán Woodman, professor. ^a

^a Centre for Cancer Epidemiology, University of Manchester, Manchester M20 4QL, ^b Withington Hospital, South Manchester University Hospitals Trust, Manchester M20 2LZ, ^c Centre for Health Policy and Planning, Keele University, Keele ST5 5BG, ^d CRC Psychological Medicine Group, Christie Hospital NHS Trust, Manchester M20 4BX

Correspondence to: P Dey paola.dey{at}cce.man.ac.uk

Objective: To determine the cost to the NHS and the impacton anxiety of a one stop clinic for assessing women with suspectedbreastcancer.
Study design: Randomised controlledtrial.
Participants: Women aged 35 or over referred with a breastlump.
Study setting: Teaching hospital, north westEngland.
Interventions: Women were randomly allocated to attend aone stop clinic or a dedicated breastclinic.
Outcome measures: Reduction in mean anxiety from baseline at24 hours after the first visit and at 3 weeks and 3 months afterdiagnosis; mean cost perpatient.
Results: 670 women were randomised. Compared with womenwho attended the dedicated clinic, patients attending the onestop clinic were less anxious 24 hours after the visit (adjustedmean change in state anxiety $-$ 5.7 (95% confidence interval $-$ 8.4to $-$ 3.0)) but not at 3 weeks or 3 months after diagnosis. Theadditional cost to the NHS of a one stop attendance was £32 perwoman; this was largely explained by greater cytopathologicaland radiological staffcosts.
Conclusion: One stop clinics may not be justified in termsof a reduction in short termanxiety.

What is already known on this topic
One stop clinics have been set up for a wide range of conditions

Rapid alleviation of anxiety has been observed in women attending a one stop clinic for assessing breast problems

The additional costs of providing this service have not been adequately quantified

What this study adds
The benefits of one stop clinics are, in the main, short term

The costs saved by the reduction in the frequency of outpatient visits are more than offset by those associated with same day reporting of diagnostic tests

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One stop breast clinics are costly and reduce only short term anxiety
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