Additional economic information Table A6.1 Summary of economic studies identified in the literature search Author Population Intervention Diagnostic accuracy and change in Economic evaluation Results of economic evaluation (year) Setting/Country management Bajaj N=922 thyroid FNAC Second opinion on outside 122/922 (13%) discordant, 44 major CBA in USD. Total cost of 922 FNAC consultations (2012) cases referred to FNAC specimens for all cases and 78 minor. Considers savings due to (assuming Medicare reimbursement institution over a referred to the institution. 75/122 (62%) resulted in change in unnecessary surgery avoided. $97/consult): $89,434. period. management: Excludes potential savings Long Island Jewish due to: Potential cost saving for 33 patients that 33 surgical to medical Medical Center in the avoided surgery (at an average cost of lost wages 29 medical to surgical United States $31,200/case): $940,166. surgical complications 13 changed surgery type life-long thyroid 39/44 (90%) major discrepancies replacement therapy, with resulted in a change in management, accompanying morbidity with 28 undergoing surgery. Of those, litigation the second opinion was supported in 25 patients and the original opinion was supported in 3 patients. Bejarano N=124 patients (125 Second opinion on outside 35/125 (28%) discordant, classified as Total cost of second opinion in Direct pathology cost at original institutions: (2001) cases) who had specimens by a major (defined as a description or USD. $18,422.45. undergone a liver hepatopathologist with a diagnosis that may have resulted in Second opinion on 125 cases: $8,490.56, biopsy and were hepatologist who shared inappropriate management decisions including: referred for treatment clinical information. All if left unmodified. $7,332.50 as professional charge by over a 2-year period. discordant diagnoses were consult pathologists University medical reviewed by another $1,158.06 for charges relating to centre in the United hepatopathologist. generation of additional slides and special States stains
Additional economic information Table A6.1 Summary of economic studies identified in the literature search Author (year) Population Setting/Country Intervention Diagnostic accuracy and change in management Economic evaluation Results of economic evaluation Bajaj (2012) N=922 thyroid FNAC cases referred to institution over a period. Long Island Jewish Medical Center in the United States Second opinion on outside FNAC specimens for all cases referred to the institution. 122/922 (13%) discordant, 44 major and 78 minor. 75/122 (62%) resulted in change in management: 33 surgical to medical 29 medical to surgical 13 changed surgery type 39/44 (90%) major discrepancies resulted in a change in management, with 28 undergoing surgery. Of those, the second opinion was supported in 25 patients and the original opinion was supported in 3 patients. CBA in USD. Considers savings due to unnecessary surgery avoided. Excludes potential savings due to: lost wages surgical complications life-long thyroid replacement therapy, with accompanying morbidity litigation Total cost of 922 FNAC consultations (assuming Medicare reimbursement $97/consult): $89,434. Potential cost saving for 33 patients that avoided surgery (at an average cost of $31,200/case): $940,166. Bejarano (2001) N=124 patients (125 cases) who had undergone a liver biopsy and were referred for treatment over a 2-year period. University medical centre in the United States Second opinion on outside specimens by a hepatopathologist with a hepatologist who shared clinical information. All discordant diagnoses were reviewed by another hepatopathologist. 35/125 (28%) discordant, classified as major (defined as a description or diagnosis that may have resulted in inappropriate management decisions if left unmodified. Total cost of second opinion in USD. Direct pathology cost at original institutions: $18,422.45. Second opinion on 125 cases: $8,490.56, including: $7,332.50 as professional charge by consult pathologists $1,158.06 for charges relating to generation of additional slides and special stains
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