title: COST ANALYSIS OF INTRA PROCEDURAL RAPID ON SITE EVALUATION OF CYTOPATHOLOGY WITH ENDOBRONCHIAL ULTRASOUND.
abstract: BACKGROUND
  Rapid on site evaluation (ROSE) allows immediate processing and interpretation of the aspirate in the procedural suite. It improves diagnostic yield and lowers patient care costs. There are limited data on its cost-effectiveness with endobronchial ultrasound (EBUS).
  
  
  METHODS
  We developed an economic model with two arms, no ROSE (our current practice) and simulated ROSE. To simulate ROSE, a cytopathologist retrospectively identified the first diagnostic slide in each case. Using a decision analytic modeling technique under a hospital diagnostic unit perspective, the benefits of simulated ROSE were estimated as cost-savings. The model input was estimated from actual data, consulting experts, and the literature. The benefits were estimated as cost savings per patient and for the province of Alberta per year. Due to differences in the procedure, sarcoidosis and cancer patients were analyzed separately. The costs are shown in 2012 Canadian dollars, CAD.
  
  
  RESULTS
  In our model without ROSE, the procedure cost/patient was CAD 646.00(USD 523.32) for cancer and CAD 1,170.00 (USD 947.73) for sarcoidosis. With simulated ROSE cost savings of CAD 63.00(37.00 to 89.00) [USD 51.04(29.97 to 72.10)], CAD 544.00(490.00 to 598.00) [USD 440.65(397.05 to 484.44)] for cancer and sarcoidosis, respectively. Extrapolating this to provincial data, our model estimates that EBUS with ROSE would lead to savings of CAD 50,000.00(30,000 to 71,000) [USD 40,501.24 (24,300.75 to 57,531.34)] for cancer and CAD 109,000.00 (87,000 to 130,000) [USD 88,337.07 (70,546.45 to 105,313.04) for sarcoidosis.
  
  
  CONCLUSIONS
  The use of ROSE with EBUS is cost saving. The projected savings were CAD 50,000.00 (USD 40,501.24) and CAD 109,000.00(USD 88,337.07) in cancer and sarcoidosis, respectively, for the province of Alberta, Canada.
authors.affiliation: Division of Respiratory Medicine,University of AlbertaKalluri@ualberta.ca.
authors.forename: Meena
authors.initials: M
authors.lastname: Kalluri
authors.affiliation: Pulmonary Research Group,University of Alberta.
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Puttagunta
authors.affiliation: School of Public Health,University of Alberta.
authors.forename: Arto
authors.initials: A
authors.lastname: Ohinmaa
authors.affiliation: School of Public Health,University of Alberta.
authors.forename: Nguyen Xuan
authors.initials: NX
authors.lastname: Thanh
authors.affiliation: Division of Respiratory Medicine,University of Alberta.
authors.forename: Eric
authors.initials: E
authors.lastname: Wong
mesh_terms: D000416:Alberta; D001980:Bronchi / Q000473:pathology*; D002170:Canada; D003362:Cost-Benefit Analysis; D003937:Diagnosis, Differential; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000191:economics*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000473:pathology*; D018803:Models, Economic; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000175:diagnosis / Q000473:pathology*
keywords: Cost savings; EBUS; Endobronchial ultrasound; Lung cancer; ROSE; Sarcoidosis