Cost Analysis of Multidisciplinary Team (MDT) Meetings in the NHS
By Professor Kevin Moore and Dr Amar S Bhogal
The NHS set up MDT meetings to enhance consistency in care, facilitate complex case management, and reduce disparities in healthcare. However, their effectiveness is increasingly overshadowed by bureaucratic inefficiencies, consuming significant clinical time without proportional benefits. Our own experience of MDTs is one of long and repetitive discussions that do not make the most of participants' expertise.
MDT inefficiencies particularly burden non-surgical specialties. For example, MDTs engage up to 15% of clinical oncologists at any given time, diverting an excessive amount of valuable time from patient care (1).
MDTs are also known to be a great financial burden to associated NHS Trusts.
But what is the true cost of an MDT?
The Financial Burden of MDT Meetings: Current Cost Analysis
MDTs cost NHS England an estimated £129.6 million annually (1). In large teaching hospitals, it is estimated that the annual cost alone just accounting for salaries of the staff in MDTs in around £800,000 (2,3). This figure is likely much higher now - that reference is based on salaries in 2010. Most studies analysing the costs of MDTs estimate the costs to be around £100-500 per case (4). This range depends highly on the number of cases an MDT can discuss, the rate of roll-over cases, the staff present for discussion, and the overall effectiveness of that MDT. For example, De Leso et al. found that the colorectal MDTs were the most expensive per case MDT, around £516 per case, due to a low number of new cases being discussed: 10 new cases(4). However, compared to the Urology MDT presented in the study, it had a cost per case of around £71 due to 41 new cases being discussed each MDT(4). (Table 1)
Table 1. Number of new patients discussed in each tumour site-specific MDM, their cost per month and cost per case
A detailed look into the above figures shows the savings to be made in even our local MDT. A breast cancer MDT we know of reviews, on average, 90 cases per week from 3 hospitals comprising 60 new cases and 30 cases of repeat discussion. Assuming an attendance of: 15 consultant surgeons, 15 resident doctors, 10 clinical nurse specialists, 3 oncologists, 2 radiologists, 2 pathologists, 5 consultant nurse practitioners, and 10 allied healthcare professionals, we can estimate that the cost of discussing 90 cases over a 4-hour period to cost between £38,300 to £49,600 per month (4), which equates to between £160 to £210 per case concluded. If re-discussion rates were reduced significantly, then a 4-hour meeting might be converted to a 3-hour meeting with an improved quality of discussion. This would result in significant financial savings to start. More importantly, it saves clinician time and makes each MDT more cost-effective for the hospital.
In a large teaching hospital, we estimate that there are approximately 20 cancer MDTs and around 80 non-cancer MDTs held every week (ranging from transplant MDTs to complex asthma MDTs to radiology meetings). Each meeting requires preparation time, invitations to be sent, and records of recommendations to be completed and entered into the clinical record. They consume an estimated 10,000 hours of clinician time per month. If each MDT was improved with effective streamlining, less roll-over of cases, MDT list management and better case discussion, this would result in savings of 25-50%. This, in turn, would save an estimated 2500 clinician hours per month as well as notional costs (~125K per month) outlined above.
Finally, it's worthwhile looking at this equation in terms of quality adjusted life years(5). Ke et al. demonstrated in their review that certain heart failure MDTs could demonstrate a cost-effectiveness ratio of around £663/QALY, while other studies showed despite the heavy cost associated with MDTs, there was no improvement in QALY when compared to non-MDT care (5). Leading to the question of what value is added from the MDT?
Strategies to Reduce MDT Meeting Costs and Improve healthcare efficiency
1.Implement Digital MDT Referral Reduces the Number of Patients Lost
The problem with current MDTs is this: referrals are made by emailing a Word document or scanned PDF which is then transferred to another document. This then forms the MDT list. This practice has many pitfalls, puts patients in danger, and needs to stop. Referring clinicians often struggle to find the MDT list contact. For example, if KM as a liver specialist detects a kidney cancer, how does one make the referral? Many hospitals make this process difficult and our experience shows how patients get lost in the system. KM recently saw a young lady with a cholangiocarcinoma whose referral was stalled in an email chain and was lost in the system until she sought a second opinion. We need to prevent situations like this from happening.
Trusts must modernise by adopting a digital MDT referral platform. We need a system that works for local, regional and national MDTs, which can be accessed anywhere, and is easy to use. This will help streamline decision-making and reduce wasted time. While these investments will inevitably demand upfront investment, the long-term savings are substantial as demonstrated by the above discussion.
2. Minimise Redundant Discussions in MDT Meetings
Too much time is wasted on incomplete discussions with missing data. Each referral should have all the required data at discussion time to prevent the MDT coordinators and other team members from manually trying to find the data. The system should export the data in a COSD-compliant manner for NHS Trusts to reduce the clinical hours required during cancer MDTs.
3. Optimise MDT
A call to Munro’s editorial piece in Clinical Oncology, MDTs were originally designed as "training wheels" for interdisciplinary collaboration (1). However, with advances in technology, guidelines, and therapies, it is time to explore more efficient models that maintain clinical rigor while reducing costs.
MDT Meetings can be valuable AND cost-effective
MDTs remain critical in modern healthcare but current inefficiencies result in significant financial costs and patient risks. Slow progress in the advancement of MDTs since their creation has meant little to no change since they were founded. Addressing these above issues through technology integration, improved workflows, and structural reforms could yield significant cost savings without compromising patient care. Whilst the time and monetary investment to action this may seem significant to start with, more cost-effective and time-efficient MDTs can benefit the NHS across the UK.
References
1. Munro AJ. Multidisciplinary team meetings in cancer care: An idea whose time has gone? Clin Oncol [Internet]. 2015;27(12):728–31. Available from: http://dx.doi.org/10.1016/j.clon.2015.08.008
2. Christopher J Fosker. Rapid Response: The Cost of the MDT. BMJ. 2010 Jul 29;
3. Taylor C, Munro AJ, Glynne-Jones R, Griffith C, Trevatt P, Richards M, et al. Multidisciplinary team working in cancer: what is the evidence? BMJ. 2010 Mar 23;340(mar23 2):c951–c951.
4. De Ieso PB, Coward JI, Letsa I, Schick U, Nandhabalan M, Frentzas S, et al. A study of the decision outcomes and financial costs of multidisciplinary team meetings (MDMs) in oncology. Br J Cancer. 2013;109(9):2295–300.
5. Ke KM, Blazeby JM, Strong S, Carroll FE, Ness AR, Hollingworth W. Are multidisciplinary teams in secondary care cost-effective? A systematic review of the literature. Cost Eff Resour Alloc [Internet]. 2013;11(1):1. Available from: Cost Effectiveness and Resource Allocation
About the Authors
Dr. Kevin Moore is a Liver Expert for the Courts, where he provides an independent opinion on the care provided by other doctors. As a Professor of Hepatology and Clinical Pharmacologist at University College London, his expertise in drug safety monitoring and adherence to national guidelines provides a unique perspective on the healthcare system's successes and failures. With over two decades of specialized experience in liver transplantation and general hepatology, he brings substantial clinical and academic authority to both patient care and medical-legal evaluations, along with a keen understanding of the practical challenges facing modern healthcare delivery.
Kevin Moore at UCL, Royal Free has authored over 100 research papers with an H index of 64 and is the author of the Oxford Handbook of Acute Medicine.
Dr. Amar S. Bhogal is a junior doctor in the United Kingdom, dedicated to enhancing patient outcomes through the integration of advanced healthcare technologies. He has a robust background in medical research, having served as a Research Assistant at University College London's Institute for Liver and Digestive Health. His work has been pivotal in exploring the application of remote technology to support acute inpatient and transitional care, particularly for individuals with chronic obstructive pulmonary disease (COPD).
Beyond clinical medicine, Dr. Bhogal has held leadership roles in both the publishing and education sectors. He worked with Elsevier as a commissioning and managing editor for oncology journals, playing a key role in curating and advancing high-impact scientific research. Additionally, he served as a director for an educational startup focused on supporting children from disadvantaged backgrounds, demonstrating his commitment to widening access to education and fostering opportunities for young learners.
Passionate about the transformative potential of healthcare technologies, Dr. Bhogal is focused on leveraging innovative solutions to improve clinical practices and patient care.
Time to be Healthcareful®