To analyze clinical and economic inappropriateness of healthcare services, the E.Pic.A study group (Economic Appropriateness of Integrated Care Pathways) evaluated seven specific key performance indicators (KPIs) on a retrospective cohort of patients with breast cancer (BC).

The dataset was extracted from cancer registers, administrative and clinical databases of the Piemonte Region. Based on current BC’s clinical guidelines, the seven KPIs were defined by a board of healthcare professionals (clinicians, data managers, healthcare managers). For each KPI, the board indicated the relative target for evaluation too. The seven KPIs analyzed three phases of the breast cancer’ integrated care pathways (ICP): diagnosis (from KPI-1 to KPI-3), surgery (KPI-4 and KPI-5) and systemic treatment/radiotherapy (KPI-6 and KPI-7).

From January 2019 to December 2019, the dataset identified and evaluated data from 624 BC patients. Diagnosis KPIs showed a possible inappropriateness around 30% of examinations performed on type I and II patients (hepatic ultrasound, computed tomography, magnetic resonance imaging, bone scan, or positron emission tomography) accounting for €135,806. The analysis on surgical re-interventions KPIs highlighted no potential inappropriateness. KPI-6 showed that 80 of 141 patients (57%) starting chemotherapy after the recommended 60 days as well as 137 of 432 patients (32%) the hormone one. KPI-7 highlighted a delay to the relative target (100% of patients initiating radiotherapy within 180 days of the last surgery, if adjuvant treatment was administered) in starting radiotherapy (44 of 102 patients). There was no significant delay (target within 270 days of the last surgery) in starting radiotherapy for patients who received adjuvant treatment.

If systematically applied to other geographic areas or to other cancer diseases, the E.Pic.A approach could allow to get a complete picture of inappropriateness with the objective to intervene with corrective and preventive actions or redirect resources to higher-value healthcare interventions.