Cost‐Effectiveness Analysis of the Milan System for Reporting Salivary Gland Cytopathology in Fine‐Needle Aspiration Cytology of Salivary Gland Lesions

INTRODUCTION: Salivary gland lesions (SGL) are a rare and heterogeneous group of benign and malignant masses. Fine-needle aspiration cytology (FNAC), guided by the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC), offers a minimally invasive method for early differentiation of SGL. The purpose of this study was to evaluate the cost-effectiveness of FNAC in diagnosing major SGL within the MSRSGC framework. METHODS: Three decision tree models were created based on probabilities from real-world and literature data. Real-world data was derived from the previously published largest single-center study evaluating FNAC performance of SGL to date. Costs were determined from German and American fee catalogs. Multiple Monte Carlo simulations were run to assess the cost-effectiveness of performing FNAC within the MSRSGC framework under different conditions for both health care systems. RESULTS: Using decision analysis, FNAC followed by surgery, if indicated, was less costly than upfront surgery. The cost reduction through FNAC was over 30% for all models. Cost reduction per case through FNAC followed by surgery, if indicated, compared to upfront surgery ranged between $5606 and $13,096 in the US model (average costs for upfront surgery: $17,472) and between 2465€ and 5337€ in the German model (average costs for upfront surgery: 8018€). When enhancing the German model with real world data, the cost reduction ranged between 2478€ and 5954€ (average costs for upfront surgery: 7988€). CONCLUSION: In this model based on MSRSGC estimates and real-world data, FNAC followed by surgery, if indicated, proved to be a more cost-efficient approach to diagnosing SGL than upfront surgery. Thus, patients and healthcare systems benefit from high-output centers that guarantee expert cytopathological diagnosis.