The cost-effectiveness of routine histologic examination

Area of Science:

• Pathology
• Health Economics
• Medical Decision Making

Background:

• Histologic examination of routine surgical tissues (e.g., hernia sacs, intervertebral discs) has a low yield for detecting clinically significant unsuspected disease.
• The cost-effectiveness of routine histologic examination remains undetermined despite its low diagnostic yield.

Purpose of the Study:

• To determine the cost-effectiveness threshold for routine histologic examination of surgical tissues.
• To establish the incidence of disease detection required for histologic examination to be considered cost-effective.

Main Methods:

• A theoretical model was developed to assess cost-effectiveness.
• Variable costs of examination and gains in life expectancy from detecting disease were incorporated.
• Calculations were based on the University of Iowa's examination cost of approximately $25.

Main Results:

• A threshold incidence of at least 1 in 2,000 examinations must detect clinically significant disease for histologic examination to be cost-effective.
• The required threshold incidence decreases with lower production costs or increased value of life-years.
• The model highlights the sensitivity of cost-effectiveness to economic factors and life expectancy valuations.

Conclusions:

• Routine histologic examination of certain tissues may not be cost-effective under current parameters.
• Further research is necessary to refine the cost-benefit analysis, considering the value of information and disease detection rates.
• Policy decisions regarding routine tissue examination require a better understanding of the cost-value trade-off.