Ultrasound-guided synovial tissue biopsy for people with rheumatoid arthritis: a micro-costing study

Objective Identify and quantify the resource use and cost per patient of performing a US-guided synovial tissue biopsy for people with RA within a routine healthcare setting.Method A micro-costing study was performed from a healthcare system perspective (National Health Service England). A service pathway conceptual model described how the procedure will be embedded within routine care to inform management decisions. Consumables were estimated from existing standard operating procedures for synovial biopsies. Staff time was estimated by expert input (clinical rheumatologist and patient). The time for tissue sample acquisition was obtained from data within the biopsy-driven R4RA trial. Unit costs were sourced from historic purchase prices, published salary scales and public-facing list prices. One-way sensitivity analysis identified key drivers of total cost per patient. Scenario analyses explored the cost impact if less senior healthcare staff performed the biopsy or if an additional outpatient appointment was required to identify joint suitability.Results The total cost of US-guided synovial tissue biopsy was 356.24 pound/patient (best-case estimate: 185.30; pound worst-case estimate: 812.46) pound. The key driver of total cost was the time taken to perform tissue sample acquisition. The total cost was lower if a registrar performed the biopsy (294.24) pound and higher if an additional outpatient appointment was required for joint selection (438.98) pound.Conclusion Interventions requiring synovial tissue samples to inform treatment selection or prognosis are emerging. The findings can inform cost parameters for future cost-effectiveness analyses. These results will help resource allocation and clinical decisions to improve the value of treatments for RA.What does this mean for patients?Treatment decisions for people with rheumatoid arthritis can be improved by examining the inflammation within the joints. Doctors can perform a procedure (called a biopsy) to examine this joint inflammation. This procedure is not currently performed in standard care. Hospitals will need a breakdown of the equipment to perform this procedure. This study determined these equipment needs and calculated the cost of the biopsy procedure for hospitals. Information from patients, rheumatologists and clinical trials was used to achieve this result. First, the analysis described the steps between doing the biopsy and talking about the results. Then the amount of healthcare staff time, equipment and cost to perform each step was assessed. The total cost of the biopsy procedure was found to be 356.24 pound/patient. The biggest influence on this total cost was the time taken to perform the biopsy procedure. These results will help doctors and hospitals find the best ways to add the biopsy procedure into their standard care. People with rheumatoid arthritis will then be able to benefit from these emerging biopsy-driven ways to improve their disease activity and health status.