Cost-effectiveness of innovations in pathology services in relation to cancer diagnosis and treatment management

Abstract

Pathology plays an important role in cancer diagnosis and treatment management, results from the pathology lab guide clinicians’ diagnosis and inform patient care plans. Pathology digitisation is expected to maximise lab efficiency when handling tissue specimens, enhance speed, provide novel information to be used by clinicians when making treatment decisions and potentially improve test accuracy. Early cancer diagnosis and personalised treatment are key players in enhancing patients’ clinical outcomes and improving quality of life. Whilst research has shown digitisation of pathology labs to be an effective intervention for better management and reporting on tissue specimens, no evaluation has reported on the economic implications of the adoption of digital systems in an NHS with limited resources. Breast cancers are the most common cancer type in the UK so any advances in accuracy or time to diagnosis due to digital pathology are expected to have a large impact on this group of patients. This thesis investigates the cost-effectiveness of digital pathology through its impacts on breast cancer patients. A discrete event simulation model representing the breast cancer pathway was constructed and used to analyse the impacts of digitisation. There was evidence of both time and cost savings for breast cancer patients as a result of pathology digitisation. A systematic review and meta-analysis compared the diagnostic accuracy of the HER2 biomarker pre- and post- the introduction of digital pathology. There was evidence of reporting precision but not of improved accuracy. Finally, a cost-effectiveness analysis comparing the two approaches found digital pathology not to be cost-effective when compared to conventional microscopes for scoring the HER2 biomarker