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Cost and Budget Impact Analysis of an Accurate Intraoperative Sentinel Lymph Node Diagnosis for Breast Cancer Metastasis.

Abstract：

BACKGROUND:Conventional intraoperative sentinel lymph node biopsy (SLNB) in breast cancer (BC) has limitations in establishing a definitive diagnosis of metastasis intraoperatively, leading to an unnecessary second operation. The one-step nucleic amplification assay (OSNA) provides accurate intraoperative diagnosis and avoids further testing. Only five articles have researched the cost and cost effectiveness of this diagnostic tool, although many hospitals have adopted it, and economic evaluation is needed for budget holders. OBJECTIVE:We aimed to measure the budget impact in Japanese BC patients after the introduction of OSNA, and assess the certainty of the results. METHODS:Budget impact analysis of OSNA on Japanese healthcare expenditure from 2015 to 2020. Local governments, society-managed health insurers, and Japan health insurance associations were the budget holders. In order to assess the cost gap between the gold standard (GS) and OSNA in intraoperative SLNB, a two-scenario comparative model that was structured using the clinical pathway of a BC patient group who received SLNB was applied. Clinical practice guidelines for BC were cited for cost estimation. RESULTS:The total estimated cost of all BC patients diagnosed by GS was US$1,023,313,850. The budget impact of OSNA in total health expenditure was -US$24,413,153 (-US$346 per patient). Two-way sensitivity analysis between survival rate (SR) of the GS and OSNA was performed by illustrating a cost-saving threshold: y ≅ 1.14x - 0.16 in positive patients, and y ≅ 0.96x + 0.029 in negative patients (x = SR-GS, y = SR-OSNA). Base inputs of the variables in these formulas demonstrated a cost saving. CONCLUSION:OSNA reduces healthcare costs, as confirmed by sensitivity analysis.

journal_name

Appl Health Econ Health Policy

journal_title

Applied health economics and health policy

authors

Saruta Y,Puig-Junoy J

doi

10.1007/s40258-016-0235-4

subject

Has Abstract

pub_date

2016-06-01 00:00:00

pages

323-35

issue

eissn

1175-5652

issn

1179-1896

pii

10.1007/s40258-016-0235-4

journal_volume

pub_type

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Cost and Budget Impact Analysis of an Accurate Intraoperative Sentinel Lymph Node Diagnosis for Breast Cancer Metastasis.