OSNA (one-step nucleic acid amplification) sentinel lymph node intraoperative molecular analysis in breast cancer: a cost-benefit analysis

Abstract

The aim of the study was to analyze the medical and economic interest of OSNA molecular technique, compared to conventional postoperative histopathologic evaluation for sentinel lymph node exploration in breast cancer patients. This retrospective cost-benefit study was conducted in the French Universitary Hospital of Saint Etienne on patients who received sentinel lymph node exploration between July 1, 2007 and December 31, 2009. Lymph nodes were analyzed by conventional postoperative histological evaluation in group 1 (82 patients) and OSNA in group 2 (86 patients). Costs were analyzed in three different ways: surgery cost, hospitalization cost and histopathologic cost. Average operating time was slightly shorter for group 1 (histology) [71.9 vs. 76.8 min for group 2 (OSNA)]. Time and operating costs were not significantly different (p = 0.293). The average cost of pathological examination was significantly higher in group 2 (35.04 euros per node in group 1 vs. 291.84 euros per node in group 2 p < 10(-3)). The average length of hospital stay was significantly longer in group 1 (5.4 days in group 1 vs. 4.2 days in group 2, p = 0.0065). The total costs were not significantly different between both groups (3,774.6 euros in group 1 vs. 3,393.9 euros in group 2 p = 0.055). The sentinel lymph node analysis with OSNA technique does not lead to higher expenses. It also avoids another surgery for 20% of patients. A prospective multicentric medico-economic study made with a larger effective would probably confirm these results.

One-step Nucleic Acid Amplification (OSNA) Fits Better with Lower Cost in Breast Cancer Axillary Management

“…Similar results have been reported in a recent cost-benefit French study in which the SLN has been analyzed by OSNA or by conventional post-operative histopathology [27]. The average pathology examination cost was markedly higher for OSNA (291.84€ vs. 35.04€); however, since the hospital stay was much longer in histopathology group due to re-hospitalization for axillary surgery (5.4 vs. 4.2 days), total cost of OSNA was lower compared to histopathology [27].…”

“…A comprehensive cost-analysis of OSNA should include three levels of assessment: surgery costs, hospitalization costs, and pathological examination costs [27]. Surgery costs mainly vary as a function of the operative times, and in our series mean time of surgery was rather higher when including OSNA intraoperative assay (67.7 vs. 63 minutes without intraoperative assessment in case of negative SLN, p = 0.066).…”

“…The average pathology examination cost was markedly higher for OSNA (291.84€ vs. 35.04€); however, since the hospital stay was much longer in histopathology group due to re-hospitalization for axillary surgery (5.4 vs. 4.2 days), total cost of OSNA was lower compared to histopathology [27]. Notably, the reported costs for histopathology examination (35.04€) were much lower than that obtained in our study, but the Authors have not included staff costs.…”

“…A less investigated feature of OSNA is cost-effectiveness, which is a matter of debate since OSNA is more expensive than morphological examination of the SLN [27]. A comprehensive cost-analysis of OSNA should include three levels of assessment: surgery costs, hospitalization costs, and pathological examination costs [27].…”

Is intraoperative touch imprint cytology indicated in the surgical treatment of early breast cancers?

“…If we use the latest intraoperative histological diagnostic method, nucleic acid amplification, it costs V172.50 to examine a lymph node, based on data from a French survey. 24 The cost for the total patient population was V362,664. Intraoperative histological examinations are less effective 4,6 and significantly increase treatment costs for patients operated on for early breast cancer.…”