A Cost-Analysis and Micro-Costing Study of the Man Van Project: Comparing Prostate-Specific Antigen Testing Via a Nurse-Led Mobile Service with Primary Care.

backgroundThe Man Van project is designed to address health inequalities and barriers to accessing healthcare related to the early diagnosis of prostate cancer with novel community-based targeting of high-risk groups using a mobile clinical unit. These inequalities are particularly relevant for men from ethnic minorities and lower socio-economic groups. We used a cost analysis with a micro-costing study to examine the costs of using the Man Van model for community-based prostate-specific antigen (PSA) testing compared with primary care-based PSA testing over the course of a 2-year period.

methodsThe Man Van service has a nurse-led model with initial counselling carried out by band 8 (pilot) or 7 (phase 2) nurses assisted by a Band 4 care support worker. The Man Van operated in North and South-West London between 2021 and 2024. PSA counselling and blood testing were performed within the same appointment. PSA testing in primary care is performed by general practitioners with counselling followed by a phlebotomy appointment. In both primary care and the Man Van service, normal results are usually texted to patients with telephone calls for abnormal results. A micro-costing study and cost analysis was undertaken to compare costs of the primary care and Man Van models of PSA testing from the perspective of the National Health Service. Baseline staffing costs were approximated from data obtained from the Personal Social Services Research Unit based in the UK and include direct and indirect overheads.

resultsA micro-costing analysis showed costs per participant seen of £81.11 in the pilot phase of the Man Van, reducing by 33% to £54.32 in phase 2. Costs per prostate cancer diagnosis were £5552.20 in the pilot, reducing to £3319.29 in phase 2. A cost analysis found a 25% saving of the Man Van model versus the primary care model with costs reducing from £68.44 to £51.11. A one-way sensitivity analysis varying individual cost inputs by ±20% showed that the total cost difference between the Man Van and primary care models ranged from a saving of approximately £2.92 to £31.72 per participant, depending on the parameter varied.

conclusionsLike all government funded healthcare services, a health-economic analysis is integral to supporting the case for the Man Van project into the future. The project has shown cost efficiency, saving a quarter of costs compared with the standard process of primary care-led PSA testing. Further work is needed to understand the economic impact, in particular of the inclusion of other health checks in the Man Van model.