Journal Article
. 2014 Sep; 5(1):33.
doi: 10.4103/2153-3539.139714.

Can digital pathology result in cost savings? A financial projection for digital pathology implementation at a large integrated health care organization

Jonhan Ho 1 Stefan M Ahlers 2 Curtis Stratman 3 Orly Aridor 4 Liron Pantanowitz 5 Jeffrey L Fine 5 John A Kuzmishin 2 Michael C Montalto 3 Anil V Parwani 5 
Affiliations
  • PMID: 25250191
  •     17 References
  •     35 citations

Abstract

Background: Digital pathology offers potential improvements in workflow and interpretive accuracy. Although currently digital pathology is commonly used for research and education, its clinical use has been limited to niche applications such as frozen sections and remote second opinion consultations. This is mainly due to regulatory hurdles, but also to a dearth of data supporting a positive economic cost-benefit. Large scale adoption of digital pathology and the integration of digital slides into the routine anatomic/surgical pathology "slide less" clinical workflow will occur only if digital pathology will offer a quantifiable benefit, which could come in the form of more efficient and/or higher quality care.

Aim: As a large academic-based health care organization expecting to adopt digital pathology for primary diagnosis upon its regulatory approval, our institution estimated potential operational cost savings offered by the implementation of an enterprise-wide digital pathology system (DPS).

Methods: Projected cost savings were calculated for the first 5 years following implementation of a DPS based on operational data collected from the pathology department. Projected savings were based on two factors: (1) Productivity and lab consolidation savings; and (2) avoided treatment costs due to improvements in the accuracy of cancer diagnoses among nonsubspecialty pathologists. Detailed analyses of incremental treatment costs due to interpretive errors, resulting in either a false positive or false negative diagnosis, was performed for melanoma and breast cancer and extrapolated to 10 other common cancers.

Results: When phased in over 5-years, total cost savings based on anticipated improvements in pathology productivity and histology lab consolidation were estimated at $12.4 million for an institution with 219,000 annual accessions. The main contributing factors to these savings were gains in pathologist clinical full-time equivalent capacity impacted by improved pathologist productivity and workload distribution. Expanding the current localized specialty sign-out model to an enterprise-wide shared general/subspecialist sign-out model could potentially reduce costs of incorrect treatment by $5.4 million. These calculations were based on annual over and under treatment costs for breast cancer and melanoma estimated to be approximately $26,000 and $11,000/case, respectively, and extrapolated to $21,500/case for other cancer types.

Conclusions: The projected 5-year total cost savings for our large academic-based health care organization upon fully implementing a DPS was approximately $18 million. If the costs of digital pathology acquisition and implementation do not exceed this value, the return on investment becomes attractive to hospital administrators. Furthermore, improved patient outcome enabled by this technology strengthens the argument supporting adoption of an enterprise-wide DPS.

Keywords: Anatomic pathology; cost; cost analysis; digital pathology; productivity; whole slide imaging.

Picture archiving and communication systems lead to sustained improvements in reporting times and productivity: results of a 5-year audit.
A D Mackinnon, R A Billington, +2 authors, U Patel.
Clin Radiol, 2008 Jun 17; 63(7). PMID: 18555038
Review of the current state of whole slide imaging in pathology.
Liron Pantanowitz, Paul N Valenstein, +5 authors, Terence J Colgan.
J Pathol Inform, 2011 Sep 03; 2. PMID: 21886892    Free PMC article.
Highly Cited.
Digital pathology: exploring its applications in diagnostic surgical pathology practice.
Ana Richelia Jara-Lazaro, Thomas Paulraj Thamboo, Ming Teh, Puay Hoon Tan.
Pathology, 2010 Sep 22; 42(6). PMID: 20854068
Review.
Implementation of whole slide imaging in surgical pathology: A value added approach.
Mike Isaacs, Jochen K Lennerz, +3 authors, John D Pfeifer.
J Pathol Inform, 2011 Oct 05; 2. PMID: 21969920    Free PMC article.
Interobserver variability between general and expert pathologists during the histopathological assessment of large-core needle and open biopsies of non-palpable breast lesions.
H M Verkooijen, J L Peterse, +8 authors, COBRA Study Group.
Eur J Cancer, 2003 Oct 03; 39(15). PMID: 14522377
Interobserver variability of histopathological prognostic parameters in cutaneous malignant melanoma: impact on patient management.
Hanna Eriksson, Margareta Frohm-Nilsson, +6 authors, Johan Hansson.
Acta Derm Venereol, 2013 Jan 12; 93(4). PMID: 23306667
Should health care systems become insurers?
Nirav R Shah, Dave A Chokshi.
JAMA, 2013 Oct 17; 310(15). PMID: 24129460
Whole-slide imaging digital pathology as a platform for teleconsultation: a pilot study using paired subspecialist correlations.
David C Wilbur, Kalil Madi, +22 authors, Wolfgang Klietmann.
Arch Pathol Lab Med, 2009 Dec 08; 133(12). PMID: 19961250    Free PMC article.
Melanoma costs: a dynamic model comparing estimated overall costs of various clinical stages.
Doru Traian Alexandrescu.
Dermatol Online J, 2009 Dec 03; 15(11). PMID: 19951637
Pitfalls in the diagnosis of malignant melanoma: findings of a risk management panel study.
David B Troxel.
Am J Surg Pathol, 2003 Sep 10; 27(9). PMID: 12960813
Quality in cancer diagnosis.
Stephen S Raab, Dana M Grzybicki.
CA Cancer J Clin, 2010 May 07; 60(3). PMID: 20444999
Review.
Inter-observer variation in the histological diagnosis of polyps in colorectal cancer screening.
Paul G van Putten, Lieke Hol, +4 authors, Monique E van Leerdam.
Histopathology, 2011 May 19; 58(6). PMID: 21585430
A filmless radiology department in a full digital regional hospital: quantitative evaluation of the increased quality and efficiency.
Andrea Nitrosi, Giovanni Borasi, +4 authors, Pietro Notari.
J Digit Imaging, 2007 Feb 24; 20(2). PMID: 17318704    Free PMC article.
Whole-slide imaging: routine pathologic diagnosis.
Toby C Cornish, Ryan E Swapp, Keith J Kaplan.
Adv Anat Pathol, 2012 Apr 14; 19(3). PMID: 22498580
Review.
Inter-institutional pathology consultations for breast cancer: impact on clinical oncology therapy recommendations.
J A Price, E Grunfeld, +2 authors, D Rayson.
Curr Oncol, 2010 Feb 25; 17(1). PMID: 20179800    Free PMC article.
Initial experience with a novel pre-sign-out quality assurance tool for review of random surgical pathology diagnoses in a subspecialty-based university practice.
Scott R Owens, Luke T Wiehagen, +5 authors, Anil V Parwani.
Am J Surg Pathol, 2010 Aug 11; 34(9). PMID: 20697250
Use of whole slide imaging in surgical pathology quality assurance: design and pilot validation studies.
Jonhan Ho, Anil V Parwani, +3 authors, John R Gilbertson.
Hum Pathol, 2006 Apr 15; 37(3). PMID: 16613327
Summary of 2(nd) Nordic symposium on digital pathology.
Claes Lundström, Sten Thorstenson, +2 authors, Darren Treanor.
J Pathol Inform, 2015 Mar 17; 6. PMID: 25774316    Free PMC article.
Distance reporting in digital pathology: A study on 950 cases.
Aleksandar Vodovnik.
J Pathol Inform, 2015 May 15; 6. PMID: 25969793    Free PMC article.
Reimagining the microscope in the 21(st) century using the scalable adaptive graphics environment.
Victor Mateevitsi, Tushar Patel, Jason Leigh, Bruce Levy.
J Pathol Inform, 2015 Jun 26; 6. PMID: 26110092    Free PMC article.
Applicability of digital analysis and imaging technology in neuropathology assessment.
William D Dunn, Marla Gearing, +4 authors, David A Gutman.
Neuropathology, 2015 Nov 19; 36(3). PMID: 26577803    Free PMC article.
Clinical Neuropathology Views - 2/2016: Digital networking in European neuropathology: An initiative to facilitate truly interactive consultations.
Miguel A Idoate, Marcial García-Rojo.
Clin Neuropathol, 2016 Feb 03; 35(2). PMID: 26833552    Free PMC article.
Consultation on urological specimens from referred cancer patients using real-time digital microscopy: Optimizing the workflow.
Henrik Holten-Rossing, Lise Grupe Larsen, +2 authors, Ben Vainer.
J Pathol Inform, 2016 Apr 15; 7. PMID: 27076989    Free PMC article.
Summary of third Nordic symposium on digital pathology.
Claes Lundström, Marie Waltersson, Anders Persson, Darren Treanor.
J Pathol Inform, 2016 May 04; 7. PMID: 27141318    Free PMC article.
An industry perspective: An update on the adoption of whole slide imaging.
Michael C Montalto.
J Pathol Inform, 2016 May 04; 7. PMID: 27141323    Free PMC article.
Gamechangers.
Ulster Med J, 2016 May 10; 85(1). PMID: 27158168    Free PMC article.
Digital pathology and anatomic pathology laboratory information system integration to support digital pathology sign-out.
Huazhang Guo, Joe Birsa, +9 authors, Liron Pantanowitz.
J Pathol Inform, 2016 May 25; 7. PMID: 27217973    Free PMC article.
Cancer diagnostics: The journey from histomorphology to molecular profiling.
Atif A Ahmed, Malak Abedalthagafi.
Oncotarget, 2016 Aug 11; 7(36). PMID: 27509178    Free PMC article.
Enterprise Implementation of Digital Pathology: Feasibility, Challenges, and Opportunities.
D J Hartman, L Pantanowitz, +3 authors, G R Lauro.
J Digit Imaging, 2017 Jan 25; 30(5). PMID: 28116576    Free PMC article.
Academic Pathology: A New Journal.
James M Crawford.
Acad Pathol, 2014 Nov 25; 1(1). PMID: 28725746    Free PMC article.
Histopathology: ditch the slides, because digital and 3D are on show.
Ilaria Jansen, Marit Lucas, +4 authors, Patricia J Zondervan.
World J Urol, 2018 Feb 06; 36(4). PMID: 29396786    Free PMC article.
Routine Digital Pathology Workflow: The Catania Experience.
Filippo Fraggetta, Salvatore Garozzo, +2 authors, Esther Diana Rossi.
J Pathol Inform, 2018 Feb 09; 8. PMID: 29416914    Free PMC article.
Being fully digital: perspective of a Dutch academic pathology laboratory.
Nikolas Stathonikos, Tri Q Nguyen, +2 authors, Paul J van Diest.
Histopathology, 2019 Jul 14; 75(5). PMID: 31301690    Free PMC article.
Review.
Orbit Image Analysis: An open-source whole slide image analysis tool.
Manuel Stritt, Anna K Stalder, Enrico Vezzali.
PLoS Comput Biol, 2020 Feb 06; 16(2). PMID: 32023239    Free PMC article.
Tailored for Real-World: A Whole Slide Image Classification System Validated on Uncurated Multi-Site Data Emulating the Prospective Pathology Workload.
Julianna D Ianni, Rajath E Soans, +9 authors, Jason B Lee.
Sci Rep, 2020 Feb 23; 10(1). PMID: 32081956    Free PMC article.
Evaluating cellularity and structural connectivity on whole brain slides using a custom-made digital pathology pipeline.
Thomas Roetzer, Konrad Leskovar, +8 authors, Adelheid Woehrer.
J Neurosci Methods, 2018 Oct 27; 311. PMID: 30365968    Free PMC article.
The Enterprise Imaging Value Proposition.
Cheryl A Petersilge.
J Digit Imaging, 2019 Nov 05; 33(1). PMID: 31677010    Free PMC article.
Review.
Evaluation and comparison between smartphone and photomicrography based whole slide imaging.
Shruthi K Patil, Mukund R Nair, A B Manjunath, B R Ahmed Mujib.
J Family Med Prim Care, 2020 Aug 06; 9(5). PMID: 32754495    Free PMC article.
Implementation of Digital Pathology Offers Clinical and Operational Increase in Efficiency and Cost Savings.
Matthew G Hanna, Victor E Reuter, +9 authors, S Joseph Sirintrapun.
Arch Pathol Lab Med, 2019 Jun 08; 143(12). PMID: 31173528    Free PMC article.
Validation of mitotic cell quantification via microscopy and multiple whole-slide scanners.
Kazuhiro Tabata, Naohiro Uraoka, +10 authors, Yukako Yagi.
Diagn Pathol, 2019 Jun 27; 14(1). PMID: 31238983    Free PMC article.
An automatic nuclei segmentation method based on deep convolutional neural networks for histopathology images.
Hwejin Jung, Bilal Lodhi, Jaewoo Kang.
BMC Biomed Eng, 2020 Sep 10; 1. PMID: 32903361    Free PMC article.
A Regulatory Science Initiative to Harmonize and Standardize Digital Pathology and Machine Learning Processes to Speed up Clinical Innovation to Patients.
Hetal Desai Marble, Richard Huang, +14 authors, Jochen K Lennerz.
J Pathol Inform, 2020 Oct 13; 11. PMID: 33042601    Free PMC article.
[Economic aspects of digitalization in orthopedics and trauma surgery].
Dominik Pförringer, David Matusiewicz, +2 authors, David A Back.
Unfallchirurg, 2020 Oct 21; 123(11). PMID: 33079219    Free PMC article.
Review.
Digital Pathology: Advantages, Limitations and Emerging Perspectives.
Stephan W Jahn, Markus Plass, Farid Moinfar.
J Clin Med, 2020 Nov 22; 9(11). PMID: 33217963    Free PMC article.
Review.
Analysis on Effects of Comprehensive Nursing Care Applied in Interventional Therapy for Patients with Liver Cirrhosis and Liver Cancer.
Yuli Gou, Jing Yi, Mei Jiang, Chunhong Cao.
Iran J Public Health, 2019 Jun 22; 48(3). PMID: 31223577    Free PMC article.
A literature review of quality, costs, process-associated with digital pathology.
Yoo Jung Kim, Eul Hee Roh, Sangchan Park.
J Exerc Rehabil, 2021 Mar 18; 17(1). PMID: 33728283    Free PMC article.
Review.
Artificial Intelligence Can Cut Costs While Maintaining Accuracy in Colorectal Cancer Genotyping.
Alec J Kacew, Garth W Strohbehn, +4 authors, Alexander T Pearson.
Front Oncol, 2021 Jun 26; 11. PMID: 34168975    Free PMC article.
Dissecting the Business Case for Adoption and Implementation of Digital Pathology: A White Paper from the Digital Pathology Association.
Giovanni Lujan, Jennifer C Quigley, +16 authors, Doug Bowman.
J Pathol Inform, 2021 Jul 06; 12. PMID: 34221633    Free PMC article.
Artificial Intelligence in Pathology.
Sebastian Försch, Frederick Klauschen, Peter Hufnagl, Wilfried Roth.
Dtsch Arztebl Int, 2021 May 25; 118(12). PMID: 34024323    Free PMC article.
Review.
Integrating digital pathology into clinical practice.
Matthew G Hanna, Orly Ardon, +3 authors, Meera R Hameed.
Mod Pathol, 2021 Oct 03;. PMID: 34599281
Review.
The Lancet Commission on diagnostics: transforming access to diagnostics.
Kenneth A Fleming, Susan Horton, +29 authors, Kamini Walia.
Lancet, 2021 Oct 10;. PMID: 34626542    Free PMC article.
Review.
A Survival Guide for the Rapid Transition to a Fully Digital Workflow: The "Caltagirone Example".
Filippo Fraggetta, Alessandro Caputo, +3 authors, Vincenzo L'Imperio.
Diagnostics (Basel), 2021 Oct 24; 11(10). PMID: 34679614    Free PMC article.