Publication:

Cost-utility analysis of outpatient department based small biopsies for diagnosis of gynecological cancers: a single centre study

Background The financial toxicity of treating cancer is exorbitant and health insurance schemes such as the Ayushman Bharat Pradhan Mantri Arogya Bima Yojna, have a great impact in mitigating this difficulty. However, package reallocation can be considered for certain surgical procedures that can be performed on an out-patient basis without requirement of admission. This study was conducted with aim of assessing cost-utility of small biopsies compared with the tier 3 to tier 1 package provided in the PMJAY scheme. The study has relevance and significance to the Indian population and similar populations in the low-middle income or even high-income countries, where the public health insurance system is implemented.

Methods This study compares the cost-utility of performing out-patient diagnostic procedures with those performed in the daycare/in-patient setting, with or without utilization of the public health insurance package. The accuracy of the procedure was assessed for biopsies performed on 145 patients evaluated in the out-patient department (OPD) in 2 years. The accuracy of small biopsy in confirmation of diagnosis and its role in decision making was assessed.

Results The study found high accuracy of outpatient procedures in confirmation of diagnosis of gynecological malignancies while being very cost-effective.

Conclusions This analysis concludes that OPD based biopsies or office procedures are very cost-effective and can significantly and positively impact out-of-pocket expenditure for patients seeking cancer treatments, while saving the costs in the insurance scheme packages.