title: The clinical and economic implications of specimen provenance complications in diagnostic prostate biopsies.
abstract: OBJECTIVE
  Inaccurate diagnoses of prostate cancer can result from transposition or contamination of patient biopsy specimens, which are known as specimen provenance complications. We assessed the clinical and economic burden of specimen provenance complications in prostate biopsies in the United States.
  
  
  METHODS
  We performed a comprehensive, systematic review of the literature to approximate the effect of specimen provenance complications on direct medical costs, patient QALYs and medicolegal costs. Data were extracted from published studies on specimen provenance complications rates, prostate cancer treatment efficacy, treatment cost, litigation/settlement costs after false diagnoses of prostate biopsies and patient quality of life. Sensitivity analysis was done to identify factors that most influenced the outcomes and assess the robustness of the findings.
  
  
  RESULTS
  Of the estimated 806,251 primary and secondary prostate biopsies performed annually in the United States 20,322 specimen provenance complications were projected to result in 4,570 clinically meaningful false diagnoses and an expected loss of 634 QALYs. The total burden of specimen provenance complications was projected to exceed $879.9 million or $3,776 per positive cancer diagnosis. This estimate was most sensitive to the indemnity cost per false-positive case and the rate of transpositions at independent reference laboratories.
  
  
  CONCLUSIONS
  The societal burden of specimen provenance complications in patients who undergo prostate biopsy exceeds $880 million annually in the United States. This analysis framework may be useful as policy makers, health organizations and researchers seek to decrease false diagnoses of prostate cancer and the consequent effects of delayed or unnecessary treatment. Further study is warranted to quantify the economic burden among additional diseases.
authors.affiliation: Comprehensive Medical Center, Royal Oak, Michigan.
authors.forename: Kirk
authors.initials: K
authors.lastname: Wojno
authors.affiliation: Stanford University School of Medicine, Stanford, California; Cedar Associates LLC, Menlo Park, California. Electronic address: ujch@stanford.edu.
authors.forename: John
authors.initials: J
authors.lastname: Hornberger
authors.affiliation: Urology of Virginia, Nassawadox, Virginia; Strand Diagnostics, Indianapolis, Indiana.
authors.forename: Paul
authors.initials: P
authors.lastname: Schellhammer
authors.affiliation: Cedar Associates LLC, Menlo Park, California.
authors.forename: Minghan
authors.initials: M
authors.lastname: Dai
authors.affiliation: Strand Diagnostics, Indianapolis, Indiana.
authors.forename: Travis
authors.initials: T
authors.lastname: Morgan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000191:economics; D003951:Diagnostic Errors / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*; D013048:Specimen Handling / Q000191:economics*; D014481:United States
keywords: biopsy; costs and cost analysis; diagnostic errors; prostate; specimen handling