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

Anna Miquel-Cases; Lotte M. G. Steuten; Lisanne S. Rigter; Wim H. van Harten

doi:10.1186/s12885-016-2653-y

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 MRIs^a	‘No of MRI scans performed’/148 MRIs^a	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 year^b	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 year^c	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 hospitals^d	‘No of MRI scans performed’/113 hospitals^e	See footnote d and e
No of patients scanned per MRI per hospital	‘No of MRI scans performed per hospital’/mean MRIs per hospital^a	‘No of MRI scans performed per hospital’/mean MRIs per hospital^a	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 year^b	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 year^c	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 findings^f	idem	[28]

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
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
Idem means calculated equal as the left cell, but adapted to the full implementation scenario figures
^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)
^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
^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
^dAssuming its use in the biggest Dutch hospital network involved in RG-NACT (see ‘resource modelling analysis’ section)
^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)
^fAfter confirming by ultrasound

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