Imaging-guided core needle biopsies (CNB) compared to surgical biopsies (SB) for soft tissue tumors: A cost-effectiveness analysis.

Abstract

10073 Background: Core-needle biopsies are rarely used outside referral centers for diagnosis of soft tissue tumours, as many surgeons prefer to perform surgical biopsies. Methods: We had conducted a decision model analysis of the cost and the effectiveness of either strategies, i.e CNB first followed by SB if CNB provides technically poor non-representative tissue versus SB first followed by CNB if necessary. The main outcome was adequate surgery for soft tissue tumor. Utility was graded as follow: 1.0 if patients with sarcoma underwent planned surgery for sarcoma or if patients with benign tumor underwent adequate treatment, 0.5 if patients with benign tumor underwent large surgery as recommended for a sarcoma and 0 if a patient with sarcoma underwent a treatment as for benign tumor. Inputs were extracted from literature data (8 reports issued between 1996 and 2005). This analysis was conducted in societal perspective with one-month time-horizon (until time of curative- intent surgery). Model and variable uncertainties were explored by Monte-Carlo probabilistic sensitivity analysis. Results: According to literature data, SB provided representative tissue in 93% of cases, Se of 84% and Sp of 100%. CNB provided representative tissue in 89% of cases, Se of 96% and Sp of 95%. Mean cost of the strategy “SB first” was 3433 Euros (± 1148) and mean effectiveness was 93.5% (±3.7). Mean cost of the strategy CNB first was 2,052 Euros (± 449) and mean effectiveness was 96.5% (± 1.1). In the base-case analysis, the strategy CNB first was less expensive and beneficial. Results were confirmed by sensitivity analysis. Conclusions: The strategy “CNB first” provided a cost-saving of 1381 Euros (1,900 US$) per patient. In France (65 millions of inhabitant/4,000 sarcoma expected each year) this strategy may provide a total cost saving of about 2,700,000 Euros per year. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Bayer