Journal: BMC medicine
This study evaluates whether liquid biopsy–based diagnosis of pediatric Burkitt lymphoma is cost-effective compared with conventional histopathology in Tanzania.
Design and methods:
- Cost-utility model: Tanzanian healthcare provider perspective, lifetime horizon.
- Timing of liquid biopsy: Assumed to be performed at first healthcare contact, enabling earlier diagnosis.
- Data sources: Resource use and outcomes from the Aggressive Infection-Related East Africa Lymphoma study.
- Health outcomes: Measured in DALYs; both costs and outcomes discounted at 5%.
- Analyses: Probabilistic, univariate sensitivity analyses and scenario analyses.
Key findings:
- Disease burden: Liquid biopsy reduced disease burden to 9.4 DALYs per patient vs 10.5 DALYs with histopathology (incremental benefit: 1.11 DALYs averted; 95% CI 0.13–2.06).
- Costs: Per-patient costs were higher by about $1,978 (95% CI $1,299–2,840), mainly due to higher diagnostic costs.
- Cost-effectiveness: Incremental cost-effectiveness ratio was $1,778 per DALY averted.
- Willingness-to-pay threshold: Liquid biopsy was more likely to be cost-effective than histopathology at thresholds above $1,890 per DALY averted.
- Sensitivity: Results were sensitive to how much earlier in the disease course diagnosis occurs, the discount rate, and diagnostic test costs.
Conclusion:
Implementing liquid biopsy to accelerate diagnosis of Burkitt lymphoma in children and young adults in Tanzania could be cost-effective, but its value depends on the timing of use in the care pathway, key modeling assumptions, and the cost-effectiveness threshold applied.