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Table 4 Resource modelling outcomes, sources and calculations

From: Cost-effectiveness and resource use of implementing MRI-guided NACT in ER-positive/HER2-negative breast cancers in The Netherlands

  Current implementation (16 hospitals, 31 MRIs) Full implementation (113 hospitals, 148 MRIs) Source
Health services required at the country level
 No of MRIs scans performed Calculations in Table 2 No of stage II-III, ER-positive/HER2-negative breast cancers in the Netherlands See Table 2
 No of patients scanned per MRI ‘No of MRI scans performed’/31 MRIsa ‘No of MRI scans performed’/148 MRIsa See footnote a
 Fte MRI technologists required Yearly hours required of MRI technologist to perform the ‘No of MRIs scans performed’/Fully workable hours of an MRI technologist a yearb idem See footnote b
 Fte breast radiologists required Yearly hours required of breast radiologist to perform the ‘No of MRIs scans performed’/Fully workable hours of a breast radiologist a yearc idem See footnote c
 No of confirmations of incidental findings (using standard imaging) Derived from the Markov model idem -
Health services required at the hospital level
 No of MRIs scans performed per hospital ‘No of MRI scans performed’/16 hospitalsd ‘No of MRI scans performed’/113 hospitalse See footnote d and e
 No of patients scanned per MRI per hospital ‘No of MRI scans performed per hospital’/mean MRIs per hospitala ‘No of MRI scans performed per hospital’/mean MRIs per hospitala See footnote a
 Fte MRI technologists required per hospital Yearly hours required of MRI technologist to perform the ‘No of MRI scans performed per hospital’/Fully workable hours of an MRI technologist a yearb idem See footnote b
 Fte breast radiologists required per hospital Yearly hours required of breast radiologist to perform the ‘No of MRI scans performed per hospital’/Fully workable hours of a breast radiologist a yearc idem See footnote c
Health outcomes gained at the country level
 No of relapses prevented Derived from the Markov model idem -
 No of breast cancer deaths prevented Derived from the Markov model idem -
Health outcomes lost at the country level
 No of excluded patients due to contraindications Derived from the Markov model idem -
 No of patients with NFS ‘No of MRI scans performed’* p of NSF idem [48]
 Fte MRI technologists with ATS ‘Fte MRI technologists required’* p of ATS idem [49]
 No of patients with CHF Derived from the Markov model idem -
 No of patients with long term AML/ADS Derived from the Markov model idem -
 No of patients with anxiety due to incidental findings Derived from the Markov model idem -
 No of patients with malignant incidental findings ‘No of confirmations of incidental findings’ *p malignant incidental findingsf idem [28]
  1. Abbreviations: No number, Fte full-time equivalent, MRI magnetic resonance imaging, RG-NACT response guided neoadjuvant chemotherapy; p probability, NSF nephrogenic systemic fibrosis, ATS acute transient symptom, CHF chronic heart failure, DSF disease free survival, R relapse, AML/ADS myelodysplastic syndrome/acute myeloid leukaemia
  2. Note that when a calculation refers to another outcome of the table this is always the outcome within the same column i.e., within the same implementation rate
  3. Idem means calculated equal as the left cell, but adapted to the full implementation scenario figures
  4. aWe search for this information in each hospital website. When this information was not available or unclear, we made use of literature [49] where the most frequent quantity of MRIs per type of hospital is presented (three for academic hospitals and one for general hospitals)
  5. bHours required of MRI technologists for the ‘No of MRIs scans performed (per hospital)’ in a year are calculated by assuming that a full scanning procedure requires 1 h of MRI technologist. Employees were assumed to work 52 weeks/year, 5 days/week i.e., 260 days/year. Of these, 40 days would be vacation and sick days, resulting thus in 220 workable days/year. Assuming workers are employed for 8 h/day this results in 1760 working hours/year. Yet workers need some time off during their working days i.e., breaks, assumed to be 20 %. Thereby, a fully workable year is of 1408 h
  6. cHours required of breast radiologist for the ‘No of MRIs scans performed (per hospital)’ in a year are calculated by assuming a mean of 6.8 min needed for a breast radiologist to interpret one MRI scan [53]. The workable hours a year of a breast radiologist were calculated exactly as explained in footnote 2
  7. dAssuming its use in the biggest Dutch hospital network involved in RG-NACT (see ‘resource modelling analysis’ section)
  8. eAssuming its use in all Dutch hospitals (locations) with MRI expected to deliver cancer treatment (i.e., university, general and specialized hospitals) (see ‘resource modelling analysis’ section)
  9. fAfter confirming by ultrasound