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

Lionel Perrier, Pauline Rascle, Magali Morelle (), Maud Toulmonde, Dominique Ranchere Vince, Axel Le Cesne (), Philippe Terrier, Agnès Neuville, Pierre Méeus (), Fadila Farsi, Françoise Ducimetière, Jean-Yves Blay (), Isabelle Ray Coquard, Jean-Michel Coindre and Dominique Heymann ()
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Magali Morelle: GATE Lyon Saint-Étienne - Groupe d'Analyse et de Théorie Economique Lyon - Saint-Etienne - ENS de Lyon - École normale supérieure de Lyon - Université de Lyon - UL2 - Université Lumière - Lyon 2 - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon - UJM - Université Jean Monnet - Saint-Étienne - CNRS - Centre National de la Recherche Scientifique
Maud Toulmonde: Institut Bergonié [Bordeaux] - UNICANCER
Dominique Ranchere Vince: Centre Léon Bérard [Lyon]
Axel Le Cesne: Département de médecine oncologique [Gustave Roussy] - IGR - Institut Gustave Roussy
Philippe Terrier: Département de biologie et pathologie médicales [Gustave Roussy] - IGR - Institut Gustave Roussy
Agnès Neuville: Institut Bergonié [Bordeaux] - UNICANCER
Pierre Méeus: Service d'Oncologie Chirurgicale - Centre Léon Bérard [Lyon], Centre Léon Bérard [Lyon]
Fadila Farsi: Réseau Espace Santé Cancer, Rhône-Alpes
Françoise Ducimetière: Département d'Oncologie Médicale - Centre Léon Bérard [Lyon], Centre Léon Bérard [Lyon]
Jean-Yves Blay: UNICANCER/CRCL - Centre de Recherche en Cancérologie de Lyon - Centre Léon Bérard [Lyon] - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon - INSERM - Institut National de la Santé et de la Recherche Médicale - CNRS - Centre National de la Recherche Scientifique
Isabelle Ray Coquard: Centre Léon Bérard [Lyon]
Jean-Michel Coindre: Plateforme de génétique moléculaire des cancers d'Aquitaine - Institut Bergonié [Bordeaux] - UNICANCER
Dominique Heymann: PhAN - Physiopathologie des Adaptations Nutritionnelles - UFR MEDECINE - Université de Nantes - UFR de Médecine et des Techniques Médicales - UN - Université de Nantes - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, Institut Bergonié [Bordeaux] - UNICANCER

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Abstract: Objective 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. Methods 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. Results 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. Conclusions 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.

Date: 2018
Note: View the original document on HAL open archive server: https://shs.hal.science/halshs-01784301v1
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Published in PLoS ONE, 2018, 13 (4), pp.e0193330. ⟨10.1371/journal.pone.0193330⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:halshs-01784301

DOI: 10.1371/journal.pone.0193330

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