A cost effectiveness analysis comparing brush biopsy to oral surgeons' conventional examination in oral cancer screening

OBJECTIVE To determine the cost effectiveness of using OralCDx brush biopsy as a routine oral cancer (OC) screening instrument compared to conventional oral examination (COE) by oral surgeons' (OS).

METHODOLOGY For this cost effectiveness analysis (CEA) study we compared two decision analysis arms: brush biopsy (99% sensitivity and 99% specificity), and COE by OS (79.6% sensitivity and 97.7% specificity). A non-reference case CEA was conducted from an insurance company perspective, including the direct costs only. Costs and healthy days gained over a period of 5-years were discounted at rate of 3% per year. Analysis of influence, two-way, and probabilistic sensitivity analyses were performed.

RESULTS The additional cost of $145.4 for brush biopsy yielded only an additional 0.0302 healthy days compared to COE, over a period of 5 years. An incremental cost effectiveness ratio (ICER) of $4813 for every healthy day gain over a 5-year period was estimated. Cost effectiveness acceptability curve derived a threshold ICER of $4857 for every healthy day gain over a period of 5 years.

CONCLUSIONS Brush biopsy can be considered cost effective only at a willingness to pay threshold of $4857 or more for every healthy day gained over a 5-year period in the target population. We believe this relatively low incremental value is not a good use of public dollars or resources, particularly when they are public dollars. However, insurance companies should use these estimates to make logical policy decisions about reimbursing this technique.