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COST ANALYSIS OF INTRA PROCEDURAL RAPID ON SITE EVALUATION OF CYTOPATHOLOGY WITH ENDOBRONCHIAL ULTRASOUND

Published online by Cambridge University Press:  11 January 2016

Meena Kalluri ,
Lakshmi Puttagunta ,
Arto Ohinmaa ,
Nguyen Xuan Thanh  and
Eric Wong
Meena Kalluri
Affiliation:
Division of Respiratory Medicine, University of AlbertaKalluri@ualberta.ca
Lakshmi Puttagunta
Affiliation:
Pulmonary Research Group, University of Alberta Department of Laboratory Medicine and Pathology, University of Alberta
Arto Ohinmaa
Affiliation:
School of Public Health, University of Alberta
Nguyen Xuan Thanh
Affiliation:
School of Public Health, University of Alberta
Eric Wong
Affiliation:
Division of Respiratory Medicine, University of Alberta Pulmonary Research Group, University of Alberta
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Abstract

Background: Rapid on site evaluation (ROSE) allows immediate processing and interpretation of the aspirate in the procedural suite. It improves diagnostic yield and lowers patient care costs. There are limited data on its cost-effectiveness with endobronchial ultrasound (EBUS).

Methods: We developed an economic model with two arms, no ROSE (our current practice) and simulated ROSE. To simulate ROSE, a cytopathologist retrospectively identified the first diagnostic slide in each case. Using a decision analytic modeling technique under a hospital diagnostic unit perspective, the benefits of simulated ROSE were estimated as cost-savings. The model input was estimated from actual data, consulting experts, and the literature. The benefits were estimated as cost savings per patient and for the province of Alberta per year. Due to differences in the procedure, sarcoidosis and cancer patients were analyzed separately. The costs are shown in 2012 Canadian dollars, CAD.

Results: In our model without ROSE, the procedure cost/patient was CAD 646.00(USD 523.32) for cancer and CAD 1,170.00 (USD 947.73) for sarcoidosis. With simulated ROSE cost savings of CAD 63.00(37.00 to 89.00) [USD 51.04(29.97 to 72.10)], CAD 544.00(490.00 to 598.00) [USD 440.65(397.05 to 484.44)] for cancer and sarcoidosis, respectively. Extrapolating this to provincial data, our model estimates that EBUS with ROSE would lead to savings of CAD 50,000.00(30,000 to 71,000) [USD 40,501.24 (24,300.75 to 57,531.34)] for cancer and CAD 109,000.00 (87,000 to 130,000) [USD 88,337.07 (70,546.45 to 105,313.04) for sarcoidosis.

Conclusion: The use of ROSE with EBUS is cost saving. The projected savings were CAD 50,000.00 (USD 40,501.24) and CAD 109,000.00(USD 88,337.07) in cancer and sarcoidosis, respectively, for the province of Alberta, Canada.

Keywords

EBUSEndobronchial ultrasoundROSECost savingsLung cancerSarcoidosis
Type
Assessments
Information
International Journal of Technology Assessment in Health Care , Volume 31 , Issue 5 , 2015 , pp. 273 - 280
Copyright
Copyright © Cambridge University Press 2016 

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Footnotes

Drs. Kalluri and Wong designed the study, performed EBUS, collected data, and drafted the manuscript. Dr. Puttagunta reviewed all the slides retrospectively and helped review the manuscript. Drs. Ohinmaa and Nguyen developed the model and performed statistical analyses; they also drafted and reviewed the manuscript. The authors thank the MSI Foundation, Edmonton, for their grant support and Dr. Humaira Iqbal for her help with data collection and abstract preparation.

References

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