Lenz-Alcayaga Rony, Paredes-Fernández Daniela, Verdejo Fancy Gaete, Páez-Pizarro Luciano, Hernández-Sánchez Karla
Universidad Andrés Bello - Public Health Institute, #700 Fernandez Concha Street, Las Condes, Santiago 7591538, Chile.
Santiago Oriente Dr. Luis Tisné Hospital - Pathology Department, #5150 Las Torres Avenue, Peñalolén, Santiago 7930124, Chile.
J Pathol Inform. 2024 Dec 20;16:100417. doi: 10.1016/j.jpi.2024.100417. eCollection 2025 Jan.
The incidence of breast cancer has risen in Chile, along with the complexity of diagnosis. For accurate diagnosis, it is necessary to complement the morphology assessed with hematoxylin and eosin with additional techniques to evaluate specific tumor markers. Evaluating the impact on costs, time, and productivity of automated techniques integrated with digital pathology solutions is crucial.
To estimate the impact on costs, time, and productivity of incorporating the automation of the HER2 in situ hybridization technique combined with integrative digital pathology (IDP) in breast cancer diagnosis in a Chilean public provider versus a manual technique.
This economic evaluation adopted a health economics multi-method approach. A decision model was developed to represent the current manual fluorescence in situ hybridization (FISH) scenario versus an automated dual in situ hybridization (DISH) plus IDP in breast cancer diagnosis. Business process management (BPM) methodology was applied for capturing working time and latencies, in combination with a time-driven activity-based costing (TDABC) methodology for estimating direct, total, and average cost (2023 USD) for both scenarios for the following vectors: Human resources, supplies, and equipment, sorted by pre-analytical, analytical, and post-analytical phases. Indirect costs (2023 USD) were also retrieved. Both BPM and TDABC served to estimate labor productivity.
In the baseline scenario based on manual FISH, the turnaround time (TAT) was estimated at 1259 min, at an average total cost of $265.67, considering direct and indirect costs for all phases. An average of 20.5 FISH reports were submitted per pathologist monthly during the baseline. The automated DISH plus IDP scenario consumed 203 min per biopsy, at an average total cost of $231.08, considering direct and indirect costs for all phases; it also showed an average of 22.8 submitted reports per pathologist monthly. This represents a decrease of 13.02% in average total costs, an 83.86% decrease in TAT, and an average labor productivity increase of 11.29%.
The incorporation of automated DISH plus IDP in the pathology department of this public provider has resulted in reductions in the time required to perform the in situ hybridization technique, a decrease in total costs, and increased productivity. Particular attention should be given to adopting new technologies to accelerate processing times and workflow.
智利乳腺癌的发病率有所上升，诊断的复杂性也随之增加。为了进行准确诊断，有必要用评估特定肿瘤标志物的附加技术来补充苏木精和伊红染色评估的形态学。评估与数字病理学解决方案集成的自动化技术对成本、时间和生产力的影响至关重要。
估计在智利一家公共医疗服务机构中，将人表皮生长因子受体2（HER2）原位杂交技术自动化并结合整合数字病理学（IDP）用于乳腺癌诊断相对于手工技术，对成本、时间和生产力的影响。
本经济评估采用卫生经济学多方法途径。开发了一个决策模型，以呈现当前乳腺癌诊断中手工荧光原位杂交（FISH）方案与自动化双原位杂交（DISH）加IDP方案的对比情况。应用业务流程管理（BPM）方法来记录工作时间和延迟情况，并结合时间驱动作业成本法（TDABC）来估计两种方案在以下方面的直接、总成本和平均成本（2023美元）：人力资源、耗材和设备，按分析前、分析和分析后阶段分类。还获取了间接成本（2023美元）。BPM和TDABC均用于估计劳动生产率。
在基于手工FISH的基线方案中，周转时间（TAT）估计为1259分钟，考虑所有阶段的直接和间接成本，平均总成本为265.67美元。在基线期间，每位病理学家每月平均提交20.5份FISH报告。自动化DISH加IDP方案每份活检耗时203分钟，考虑所有阶段的直接和间接成本，平均总成本为231.08美元；每位病理学家每月平均提交报告数量也为22.8份。这意味着平均总成本下降了13.02%，TAT下降了83.86%，平均劳动生产率提高了11.29%。
在这家公共医疗服务机构的病理科采用自动化DISH加IDP技术，减少了原位杂交技术所需时间，降低了总成本，并提高了生产力。应特别关注采用新技术以加快处理时间和工作流程。
