Cost Analysis of Thyroid Fine Needle Aspiration (FNA) On-Site Evaluation (OSE)
Lisa A Pitelka-Zengou, Kyle Zanocco, Sharvari Dalal, Cord Sturgeon, Ritu Nayar. Northwestern Memorial Hospital, Chicago, IL
Background: Experienced operators with high adequacy rates for thyroid FNA may not benefit from OSE. OSE increases cost and length of procedure. Furthermore, in high volume centers, time, resource and reimbursement issues constrain the ability to provide OSE for every thyroid FNA. We hypothesized that rather than perform routine OSE, it would be less costly to limit the performance of OSE to repeat FNA after initial unsatisfactory FNA.
Design: A formal decision model was constructed using nested algorithms to compare strategies of routine OSE versus select OSE after unsatisfactory FNA. All FNAs with OSE were assumed to be adequate. Three passes were assumed to be performed for each FNA. Adequacy rates for FNA without OSE were estimated from contemporary institutional data and literature review. Medicare reimbursement data were used to estimate costs in 2011 USD in order to maintain a 3rd party payer perspective. Sensitivity analysis was used to examine the uncertainty of costs and probabilities in the model.
Results: OSE strategy had an overall cost of $582.57. FNA without OSE cost $529.96, producing cost savings of $52.61. Performance of initial FNA without OSE remained cost-saving until the adequacy rate of submitted samples fell to the threshold value of 81% or the cost of OSE fell to $52.41. Institutional data showed an unsatisfactory rate of 40% when an initial unsatisfactory FNA was re-attempted without OSE. The decision to perform OSE on all repeat FNAs produced cost savings of $122.16.
Conclusions: The strategy of routine OSE for all thyroid FNAs was more costly than selective OSE for initial unsatisfactory biopsies unless the initial adequacy rate was less than 81%. OSE after 1st unsatisfactory biopsy was the least costly selective OSE strategy as long as the repeat FNA inadequacy rate was less than 81%. This study was limited to the evaluation of cost only and does not take into account the factors of procedure length, delay in diagnosis, or patient time and discomfort.
Wednesday, March 21, 2012 1:00 PM
Poster Session VI # 55, Wednesday Afternoon