Human Resources Costs in Breast Cancer Biopsy Processing in Chile: What's the Impact of Human Resources?

OBJECTIVES:

No evidence of human resources (HR) costs in processing breast cancer biopsies is available in the Chilean public sector. This analysis aims to estimate the impact of HR on direct costs, considering the effects of time in costs in a local pathology laboratory responsible for processing 8.8% of national breast cancer intraoperative biopsies (IB).

METHODS:

Time-Driven Activity-Based Costing (TDABC). A comprehensive Business Process Management Notation diagram was constructed to represent human resources activities dedicated to processing biopsies based on fieldwork. Turn-Around Time (TAT) was calculated. Time was studied as direct working time (DWT) and latencies (measured in hours) for each biopsy technique: Intraoperative biopsy (IB), Hematoxylin and Eosin staining (H&E), Immunohistochemical study (IS), and FISH HER-2 determination.

RESULTS:

Direct costs of IB, H&E, IS, and FISH determination were USD$23.0, USD$41.6, USD$91.1, and USD$148.8, respectively. HR costs in IB represent 44.6% of direct costs. DWT in IB was 0.55 hours versus 0.05 in latencies. In the case of H&E, HR explained 92.4% of direct costs, with a DWT of 1.44 hours and 35.47 hours in latencies. In IS, HR explained 47.8% of direct costs, at a TAT of 6.98 hours, composed of 1.07 of DWT. HR in FISH determination weighted 15.3% of direct cost, at a TAT of 33.58 hours and 2.51 DWT. For biopsies requiring H&E, IS, and FISH, a TAT of 77.47 hours was estimated.

CONCLUSIONS:

In a local context of increasing demand for breast cancer diagnosis, the TAT observed results, human resources impact on direct costs, and scarcity of pathologists in the public sector, should be all factors to consider incorporating new diagnostic devices to improve laboratory workflow and decrease TAT. These measurements are relevant in decision-making processes and health technology assessment of diagnostic devices.