Cost analysis of breast cancer diagnostic assessment programs.

G.N Honein-Abouhaidar,J S Hoch,A R Gagliardi,D R Mccready,M J Dobrow,T Stuart-Mcewan

doi:10.3747/co.24.3608

Abstract

Diagnostic assessment programs (daps) appear to improve the diagnosis of cancer, but evidence of their cost-effectiveness is lacking. Given that no earlier study used secondary financial data to estimate the cost of diagnostic tests in the province of Ontario, we explored how to use secondary financial data to retrieve the cost of key diagnostic test services in daps, and we tested the reliability of that cost-retrieving method with hospital-reported costs in preparation for future cost-effectiveness studies. We powered our sample at an alpha of 0.05, a power of 80%, and a margin of error of ±5%, and randomly selected a sample of eligible patients referred to a dap for suspected breast cancer during 1 January-31 December 2012. Confirmatory diagnostic tests received by each patient were identified in medical records. Canadian Classification of Health Intervention procedure codes were used to search the secondary financial data Web portal at the Ontario Case Costing Initiative for an estimate of the direct, indirect, and total costs of each test. The hospital-reported cost of each test received was obtained from the host-hospital's finance department. Descriptive statistics were used to calculate the cost of individual or group confirmatory diagnostic tests, and the Wilcoxon signed-rank test or the paired t-test was used to compare the Ontario Case Costing Initiative and hospital-reported costs. For the 191 identified patients with suspected breast cancer, the estimated total cost of $72,195.50 was not significantly different from the hospital-reported total cost of $72,035.52 (p = 0.24). Costs differed significantly when multiple tests to confirm the diagnosis were completed during one patient visit and when confirmatory tests reported in hospital data and in medical records were discrepant. The additional estimated cost for non-salaried physicians delivering diagnostic services was $28,387.50. It was feasible to use secondary financial data to retrieve the cost of key diagnostic tests in a breast cancer dap and to compare the reliability of the costs obtained by that estimation method with hospital-reported costs. We identified the strengths and challenges of each approach. Lessons learned from this study have to be taken into consideration in future cost-effectiveness studies.

Highlights

Diagnosis is a crucial component in the spectrum of cancer management
Costs differed significantly when multiple tests to confirm the diagnosis were completed during one patient visit and when confirmatory tests reported in hospital data and in medical records were discrepant
We used as a case example the breast cancer dap services situated in a teaching hospital in Ontario, where the health system is publicly funded

Summary

Introduction

Diagnosis is a crucial component in the spectrum of cancer management. Linkage between primary and secondary care, and coordination of multiple procedures and health professionals, is essential to achieve a timely diagnosis, which can potentially be associated with improved cancer outcomes[1,2]. Various factors can delay diagnosis and contribute to poor clinical outcomes and a poor patient experience. Those factors include limited access to diagnostic tests; problems identifying, communicating with, and referring to specialists; and limited availability of human and technical resources[3,4]. Centralized diagnostic assessment programs (daps) appear to overcome those challenges and minimize diagnostic delays by improving access to specialist care[5,6,7]. A dap can lessen the time from first referral to specialist visit and the time to first treatment, and can improve patient satisfaction with services and personal care received[8,9]

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