Evaluation of Liquid Cytology Cost-Effectiveness in Examination of Urine Cellular Sediment
Purpose. To conduct a comparative analysis of financial assets required for implementation of liquid and traditional methods of urine cell sediment cytology used in this work to substantiate the economic efficiency and feasibility of implementing the liquid cytology method into the practice of cytology laboratories. Materials and methods. Cytological preparations of urine sediment were prepared using the methods of traditional (TC) and liquid cytology (LC). A total of 826 outpatient follow-up cards were analyzed including those of patients with an established diagnosis of urothelial carcinoma (n=682) and suspected of this pathology (n=144). Indicators of diagnostic sensitivity, specificity and accuracy of cytological examination methods are calculated. To assess the economic efficiency of TC and LC in the study of cellular urine sediment, the cost-effectiveness analysis was used. Results. A comparative analysis of diagnostic efficiency of the traditional method by simple centrifugation and LC method was carried out. A total of 826 outpatient follow-up cards were analyzed including those of patients with an established diagnosis of urothelial carcinoma (n=682) and suspected of this pathology (n=144). LC method significantly increased the diagnostic sensitivity (92.54%), specificity (94.21%), and diagnostic accuracy of cytological examination (94.45%). The diagnostic sensitivity, specificity, and diagnostic accuracy of the cytological examination performed by TC method were only 42.28%, 91.53%, and 44.51%, respectively. When assessing the cost-effectiveness ratio (cost effectiveness analysis - CEA) of the analyzed methods, it was established that LC method produced 3 times less costs per unit of efficiency (0.918 / 0.302) as compared to cytological examination performed by TC method. When calculating the economic effect of optimizing the norms of clinical laboratory diagnostician working hours (cost minimization analysis - CMA) the total cost of the service is lowered by 1.98 rubles, which reduces the CEA coefficient by 7% (in values for July - August 2022). Conclusions. The comparative analysis of the cost-effectiveness of TC and LC methods in examination of cellular urine sediment in terms of labor time and financial resources revealed significant advantages of LC method. Given the diagnostic value and cost- effectiveness of LC method, it is advisable to include it in the mandatory range of laboratory diagnostic tests in patients with suspected malignant neoplasms of the urinary tract.