Breast cancer molecular diagnostics in Rwanda: a cost-minimization study of immunohistochemistry versus a novel GeneXpert ® mRNA expression assay.
| Autor: | Erfani P; Harvard Medical School, Boston, United States of America (USA)., Gaga E; University of Global Health Equity, Butaro, Rwanda., Hakizimana E; Ministry of Health, Butaro Hospital, Butaro, Rwanda., Kayitare E; Ministry of Health, Butaro Hospital, Butaro, Rwanda., Mugunga JC; Partners In Health, Boston, USA., Shyirambere C; Partners In Health/Inshuti Mu Buzima, Butaro, Rwanda., Milner DA; American Society for Clinical Pathology, Chicago, USA., Shulman LN; Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA., Ruhangaza D; Ministry of Health, Butaro Hospital, Butaro, Rwanda., Fadelu T; Dana-Farber Cancer Institute, 450 Brookline Avenue, MA-1B-17, Boston, Massachusetts02215, USA. |
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| Jazyk: | angličtina |
| Zdroj: | Bulletin of the World Health Organization [Bull World Health Organ] 2023 Jan 01; Vol. 101 (1), pp. 10-19. Date of Electronic Publication: 2022 Nov 02. |
| DOI: | 10.2471/BLT.22.288800 |
| Abstrakt: | Objective: To compare the financial and time cost of breast cancer biomarker analysis by immunohistochemistry with that by the Xpert ® STRAT4 assay. Methods: We estimated costs (personnel, location, consumables and indirect) and time involved in breast cancer diagnosis at the Butaro Cancer Centre of Excellence, Rwanda, using time-driven activity-based costing. We performed a cost-minimization analysis to compare the cost of biomarker analysis for estrogen receptor, progesterone receptor and human epidermal growth factor receptor-2 status with immunohistochemistry versus STRAT4. We performed sensitivity analyses by altering laboratory-specific parameters for the two methods. Findings: We estimated that breast cancer diagnosis in Rwanda costs 138.29 United States dollars (US$) per patient when conducting biomarker analysis by immunohistochemistry. At a realistic immunohistochemistry antibody utilization efficiency of 70%, biomarker analysis comprises 48.7% (US$ 67.33) of diagnostic costs and takes 33 min. We determined that biomarker analysis with STRAT4 yields a reduction in diagnosis cost of US$ 7.33 (10.9%; 7.33/67.33), and in pathologist and technician time of 20 min (60.6%; 20/33), per patient. Our sensitivity analysis revealed that no cost savings would be made in laboratories with antibody utilization efficiencies over 90%, or where only estrogen and/or progesterone receptor status are assessed; however, such operational efficiencies are unlikely, and more laboratories are pursuing human epidermal growth factor receptor-2 analysis as targeted therapies become increasingly available. Conclusion: Breast cancer biomarker analysis with STRAT4 has the potential to reduce the required human and capital resources in sub-Saharan African laboratories, leading to improved treatment selection and better clinical outcomes. ((c) 2023 The authors; licensee World Health Organization.) |
| Databáze: | MEDLINE |
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