The cost-saving effect of centralized histological reviews with soft tissue and visceral sarcomas, GIST, and desmoid tumors: The experiences of the pathologists of the French Sarcoma Group.
The cost-saving effect of centralized histological reviews with soft tissue and visceral sarcomas, GIST, and desmoid tumors: The experiences of the pathologists of the French Sarcoma Group.
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DOI：
10.1371/journal.pone.0193330
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Coindre JM
中科院分区：
文献类型：
--
作者：
Perrier L;Rascle P;Morelle M;Toulmonde M;Ranchere Vince D;Le Cesne A;Terrier P;Neuville A;Meeus P;Farsi F;Ducimetière F;Blay JY;Ray Coquard I;Coindre JM
本研究探讨了软组织和内脏肉瘤、胃肠道间质瘤（GIST）和硬纤维瘤诊断中出现的不一致类型，以及诊断差异的经济影响。我们使用前瞻性实施的数据库对2010年法国RRePS网络中的一组患者进行了回顾性多中心分析。根据2013年世界卫生组织（WHO）的分类，诊断被认为是不一致的。探讨不一致诊断的预测因素。使用决策树评估两种疾病管理策略的预期成本：一种基于集中组织学审查后的修订诊断（选项1），另一种基于未经集中审查的诊断（选项2）。两者都是根据国家或国际指南，根据患者和疾病特征定义的。时间范围为12个月，并保留了法国国家健康保险的观点。2013年的费用以欧元表示。敏感性分析使用低和高情景进行，包括± 20%的成本估计值。共纳入2,425例患者。341例患者（14%）接受了不一致的诊断。这些不一致主要是诊断为肉瘤的良性肿瘤（n = 124）或诊断为肉瘤的非肉瘤恶性肿瘤（n = 77）。与脂肪肉瘤相比，硬纤维瘤最终诊断的不一致性概率更高（比值比= 5.1; 95%CI [2.6-10.4]）。基础病例分析（低和高病例情景）的每例患者预期成本为：选项1为8，791欧元（分别为7，033欧元和10，549欧元），选项2为8，904欧元（分别为7，057欧元和10，750欧元）。我们的研究结果强调了肉瘤的误诊，发现肉瘤最常与良性肿瘤混淆。集中的组织学审查可能为法国NHI节省成本。
This study examined the types of discordance occurring in the diagnosis of soft tissue and visceral sarcomas, gastrointestinal stromal tumors (GIST), and desmoid tumors, as well as the economic impact of diagnostic discrepancies. We carried out a retrospective, multicenter analysis using prospectively implemented databases performed on a cohort of patients within the French RRePS network in 2010. Diagnoses were deemed to be discordant based on the 2013 World Health Organization (WHO) classification. Predictive factors of discordant diagnoses were explored. A decision tree was used to assess the expected costs of two strategies of disease management: one based on revised diagnoses after centralized histological review (option 1), the other on diagnoses without centralized review (option 2). Both were defined based on the patient and the disease characteristics, according to national or international guidelines. The time horizon was 12 months and the perspective of the French National Health Insurance (NHI) was retained. Costs were expressed in Euros for 2013. Sensitivity analyses were performed using low and high scenarios that included ± 20% estimates for cost. A total of 2,425 patients were included. Three hundred forty-one patients (14%) had received discordant diagnoses. These discordances were determined to mainly be benign tumors diagnosed as sarcomas (n = 124), or non-sarcoma malignant tumors diagnosed as sarcomas (n = 77). The probability of discordance was higher for a final diagnosis of desmoid tumors when compared to liposarcomas (odds ratio = 5.1; 95%CI [2.6–10.4]). The expected costs per patient for the base-case analysis (low- and high-case scenarios) amounted to €8,791 (€7,033 and €10,549, respectively) for option 1 and €8,904 (€7,057 and €10,750, respectively) for option 2. Our findings highlight misdiagnoses of sarcomas, which were found to most often be confused with benign tumors. Centralized histological reviews are likely to provide cost-savings for the French NHI.
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影响因子：
3.8
作者：
Lurkin A;Ducimetière F;Vince DR;Decouvelaere AV;Cellier D;Gilly FN;Salameire D;Biron P;de Laroche G;Blay JY;Ray-Coquard I
通讯作者：
Ray-Coquard I
影响因子：
5.6
作者：
Epstein, JI;Walsh, PC;Sanfilippo, F
通讯作者：
Sanfilippo, F
影响因子：
45.3
作者：
Kennecke, Hagen F.;Speers, Caroline H.;Hayes, Malcolm
通讯作者：
Hayes, Malcolm
影响因子：
3.7
作者：
Ducimetière F;Lurkin A;Ranchère-Vince D;Decouvelaere AV;Péoc'h M;Istier L;Chalabreysse P;Muller C;Alberti L;Bringuier PP;Scoazec JY;Schott AM;Bergeron C;Cellier D;Blay JY;Ray-Coquard I
通讯作者：
Ray-Coquard I
影响因子：
4.5
作者：
Karnon, Jonathan;Stahl, James;Moller, Jorgen
通讯作者：
Moller, Jorgen