High Costs and Low Healthy Days Gained by Using OralCDx Brush Biopsy as a Routine Oral Cancer Screening Instrument Compared to Conventional Oral Examination

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). Background. Though it is important that new oral cancer diagnostics are made available for public’s use, it is even more imperative to question if they are effective in truly detecting oral cancer, and if the money spent on them is justifiable for the health outcomes achieved. Methods. For this cost effectiveness analysis (CEA) study we compared two decision analysis arms: brush biopsy and COE, 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 $138 for brush biopsy yielded only an additional 0.0410 healthy days compared to COE, over a period of 5 years. Cost effectiveness acceptability curve derived a threshold ICER of $3441 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 $3441 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. However, insurance companies should use these estimates to make logical policy decisions about reimbursing this screening instrument.