An Economic Model for Rapid On-Site Evaluation (ROSE) Telecytology to Improve Remote Access and Pathology Practice

Abstract Introduction/Objective Rapid On-Site Evaluation (ROSE) is an integral part of the fine needle aspiration (FNA) procedure to inform on the diagnostic adequacy of the passes already taken. However, traditional ROSE is not accessible in rural areas and takes valuable cytopathologist time to travel to attend the procedure on site. Telecytology has the promise to allow remote access with equivalent accuracy, though an economic benefit model based on the literature is sparse. Methods/Case Report Mean traditional ROSE times for cytopathologists and mean telecytology ROSE times from two institutions each from the literature were reviewed. The savings by telecytology ROSE was then modeled using the 2019 Medscape Physician Compensation Report (MPCR). Literature review of the nondiagnostic rate both with and without ROSE and costs reported from the University of Pennsylvania were used to model savings from increased accessibility of ROSE to remote settings by telecytology. Results (if a Case Study enter NA) Telecytopathologist traditional ROSE time (20.95 minutes and 56.2 minutes) and telecytology ROSE time (2.91 minutes and 7.5 minutes) was noted. The average pathologist salary per the 2019 MPCR was $120 per hour. The preceding corresponds to monetary savings of $26.90 to $106.58 per case. At one of the reviewed institutions, this would correspond to $23,672 to $93,790.40 in yearly savings. An average reported non- diagnostic rate of 20% (without ROSE with cost of $3,096 per FNA procedure) versus 0.98% (with ROSE with cost of $3327 per procedure) was noted, which if each non-diagnostic FNA results in a repeat procedure, leads to $32,186 in savings per 100 patients. Conclusion Telecytology has promise in not only improving economic efficiency of the ROSE procedure over traditional ROSE, but also in cost savings in remote settings that would otherwise not have access to ROSE at all. Therefore, there are economic savings that could be realized by improving access to telecytology across settings.