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Cost analysis of the diagnosis and treatment of soft tissue sarcomas in reference centres
Análisis de los costes de diagnóstico y tratamiento de los sarcomas de partes blandas en centros de referencia
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"apellidos" => "Ortiz-Cruz" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía Ortopédica y Traumatología, Hospital MD Anderson Cancer Center, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Análisis de los costes de diagnóstico y tratamiento de los sarcomas de partes blandas en centros de referencia" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 845 "Ancho" => 1164 "Tamanyo" => 39035 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Gender distribution of patients included in the study.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Sarcomas are malignant tumours derived from mesenchymal tissue. Among them, STS are more common than bone sarcomas. Nevertheless, STS are a rare type of cancer. The diagnosis and treatment of this condition requires the collaboration of multiple specialists. Due to its rarity and the need for a multidisciplinary team with sufficient experience, multiple studies have shown that referring these patients to reference centres decreases morbidity and mortality.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–5</span></a> In addition, wrong decision-making also involves an increase in healthcare expenditure.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and methods</span><p id="par0010" class="elsevierStylePara elsevierViewall">We present a historical cohort study of 52 consecutive patients referred to our centres between 2009 and 2011 with a diagnosis of soft tissue sarcoma. Out of these patients, 2 were excluded from the study due to a lack of the necessary variables for analysis and another 2 patients were excluded because they had not completed the definitive treatment. Of the 48 patients included in the study, 32 were male and 16 were female (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), with a mean age of 56 years (range: 18–89 years). The follow-up period lasted for 22.90 months (±12.8 months).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The most common histological type was malignant fibrous histiocytoma (10/48 patients: 20.83%), followed by synovial sarcoma (8/48 patients: 16.66%) and leiomyosarcoma (7/48 patients: 14.58%) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The tumours were classified according to the American Joint Committee on Cancer (AJCC) classification for STS.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> This classification considers as superficial tumours those located exclusively above the superficial fascia without invading it and as deep tumours those located below the superficial fascia or else those which are above the superficial fascia but invade it. According to this classification, 27.08% of our sample (13/48 patients) was included in stages IA, IB, IIA or IIB and 72.91% (35/48) in stages III or IV (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The most common locations were the lower limbs, in 81.25% of cases (39/48 patients), followed by the upper limbs in 14.58% (7/48 patients) and the axial skeleton in 4.16% (2/48 patients) (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The costs derived from diagnosis and treatment were divided into 4 groups. Group I included the diagnostic costs prior to referral, group II included those after referral, group III included those derived from the treatment prior to referral and group IV included treatment costs after referral.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In addition, patients were divided into 2 further groups: 21 patients (43.75%) who were referred prior to biopsy (group A) and 27 patients (56.25%) who were referred after biopsy (group B). There were no significant differences between both groups in terms of age or gender. We considered as a treatment any procedure performed not only with the intention of identifying the disease, but also of eliminating it. Therefore, excisional biopsies were considered as a part of the treatment.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The costs derived from treatment included surgical and nonsurgical procedures, as well as the complications derived from both.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The diagnostic cost of simple radiographs and those caused by routine monitoring of patients were not counted.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The costs included due to procedures were obtained from public prices as per 2009.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Data were analysed using the software packages SAS<span class="elsevierStyleSup">®</span> version 9.2 and Enterprise Guide<span class="elsevierStyleSup">®</span> 4.2. We conducted a comparative study through the Wilcoxon and Mann–Whitney U tests.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">The overall cost of treating all patients referred for definitive treatment at our centres due to soft tissue sarcoma between 2009 and 2011 was 692,524.00€. The mean cost per patient was 14,427.58€. In group A (patients referred before biopsy), the mean overall cost was 11,818.67€ (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), while for those in whom the referral was delayed until after a biopsy was obtained, the mean cost per patient was 16,456.74€ (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). This difference was statistically significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.0073).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">There were no significant differences in diagnostic cost considered separately between groups A and B. However, the mean treatment cost per patient was higher in group B (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.0121).</p><p id="par0050" class="elsevierStylePara elsevierViewall">The incidence of complications was higher among patients in group B, although this difference did not reach statistical significance.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The times until local recurrence of sarcomas and until appearance of metastasis were analysed by Kaplan–Meier curves. However, due to the low number of events (13% cases of local recurrence in group A and 24% in group B) we did not find a significant association between the timing of referral to the reference centre and local or distant relapse.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">Several studies have demonstrated that referral to multidisciplinary reference centres, where different specialists involved in the treatment of primary cancer work together, improves the likelihood of survival and limb salvage.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,9</span></a> The economic cost of limb salvage surgery and amputation surgery are considered to be similar,<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,11</span></a> although social integration and self-perception are notably better in salvage surgery.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,12</span></a> However, we should attempt to consider the real benefits in quality of life and use them to justify the cost incurred.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The literature shows that patients treated at non-reference centres suffer more local recurrences without an increased number of metastases and also generate higher costs.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> In our work, we obtained the same findings, attributable to the cost of reoperation after local recurrence and to the need for further adjuvant treatments.</p><p id="par0070" class="elsevierStylePara elsevierViewall">In this preliminary study, we also aimed to find a lower healthcare cost in patients who were referred to reference centres before biopsy compared to those derived after undergoing invasive procedures.</p><p id="par0075" class="elsevierStylePara elsevierViewall">There was no significant difference in the diagnostic cost considered separately between groups A and B. These results could be due to the anatomopathological diagnostic method employed at our centres, which in all cases included a percutaneous biopsy guided by a diagnostic ultrasound or CT scan. This procedure increased our diagnostic costs, whereas in other centres, biopsy was generally excisional and, therefore, considered as part of the treatment. Nevertheless, this difference did not reach statistical significance.</p><p id="par0080" class="elsevierStylePara elsevierViewall">However, the mean treatment cost per patient was higher in group B (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.0121). We believe that, in our study, this difference was due to the cost of reoperation after local recurrence and the need for further adjuvant therapies, which could be prevented through adequate diagnostic and therapeutic planning.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Our study was a preliminary assessment in which we observed a significant decrease in overall and treatment costs when STS cases were referred to multidisciplinary reference centres before biopsy. In our opinion, this difference was due to several factors. Firstly, there was an increased percentage of unplanned excisional biopsies in which sarcomas were only discovered after surgery. This then required reoperation in order to extend margins, adjuvant radiotherapy or entailed a higher rate of local recurrences which, as we have seen, increased the overall cost. Secondly, there was a trend towards more complications in patients in group B.</p><p id="par0090" class="elsevierStylePara elsevierViewall">It would be interesting to increase the number of cases studied in order to enable a meaningful assessment of cost effectiveness curves, including radiographs and consultation time, as well as adjustment to quality of life.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Level of evidence</span><p id="par0095" class="elsevierStylePara elsevierViewall">Level of evidence IV.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical responsibilities</span><p id="par0100" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Protection of people and animals</span>. The authors declare that this investigation did not require experiments on humans or animals.<span class="elsevierStyleVsp" style="height:0.5px"></span><span class="elsevierStyleBold">Confidentiality of data</span>. The authors declare that this work does not reflect any patient data.<span class="elsevierStyleVsp" style="height:0.5px"></span><span class="elsevierStyleBold">Right to privacy and informed consent</span>. The authors declare that this work does not reflect any patient data.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interests</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres116669" "titulo" => array:6 [ 0 => "Abstract" 1 => "Objective" 2 => "Materials and methods" 3 => "Results" 4 => "Discussion" 5 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec103954" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres116670" "titulo" => array:6 [ 0 => "Resumen" 1 => "Objetivo" 2 => "Material y métodos" 3 => "Resultados" 4 => "Discusión" 5 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec103955" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Level of evidence" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Ethical responsibilities" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interests" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-04-06" "fechaAceptado" => "2012-06-12" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec103954" "palabras" => array:3 [ 0 => "Sarcoma" 1 => "Cost" 2 => "Reference" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec103955" "palabras" => array:3 [ 0 => "Sarcoma" 1 => "Coste" 2 => "Referencia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To determine the diagnostic and treatment costs in patients referred to a reference centre with a suspected soft tissue sarcoma.</p> <span class="elsevierStyleSectionTitle">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The study consisted of a historic cohort of 48 consecutive patients who were diagnosed with soft tissue sarcomas (STS) and treated in our centres between the years 2009 and 2011, both prior to and after performing the biopsy. The cost per procedure was taken from the official list of prices published in the year 2009. A comparative study of the data was performed using the Mann–Whitney U and Wilcoxon tests.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The mean cost per patient was 14,427.58€. In those referred before the biopsy, the overall mean cost was 11,818.67€, and in those referred afterwards, it was 6456.74€ (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.0073). There were no significant differences in the diagnostic costs between the groups. However, the mean cost of the treatment per patient was higher in the second group (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.0121).</p> <span class="elsevierStyleSectionTitle">Discussion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The referral to centres with experienced multidisciplinary teams in this disease is a common fact highlighted in many articles, where the financial savings have also been demonstrated.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">This study shows that, in addition to improving the care aspect of the patients when they are referred to a specialist centre prior to the biopsy, there is also a lower health care cost.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Conocer los costes diagnósticos y terapéuticos en pacientes derivados a un centro de referencia ante la sospecha de un sarcoma de partes blandas.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Cohorte histórica de 48 pacientes consecutivos diagnosticados y tratados en nuestros centros, tanto previo a la realización de la biopsia como posteriormente a ella, entre los años 2009 y 2011 con el diagnóstico de sarcoma de partes blandas. Los costes por procedimiento son extraídos de la orden de precios públicos del año 2009. Se realizó un estudio comparativo de los datos mediante la prueba de <span class="elsevierStyleItalic">U</span> de Mann–Whitney–Wilcoxon.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El coste medio por paciente fue de 14.427,58 €. En los derivados previo a la biopsia el coste global medio fue de 11.818,67 € y en los derivados posteriormente fue de 16.456,74 € (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,0073). No existen diferencias significativas en el coste diagnóstico entre ambos grupos. Sin embargo, el coste del tratamiento medio por paciente fue mayor en el grupo B (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,0121).</p> <span class="elsevierStyleSectionTitle">Discusión</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La derivación a los centros de referencias con equipos multidisciplinares expertos en esta afección es un hecho común resaltado en muchos artículos en los que además se demuestra el ahorro económico que esto supone.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">En este estudio podemos ver que además de la mejoría en el aspecto asistencial para el paciente cuando se deriva a un centro especializado previo a la biopsia existe un menor coste sanitario.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Barrientos-Ruiz I, et al. Análisis de los costes de diagnóstico y tratamiento de los sarcomas de partes blandas en centros de referencia. Rev Esp Cir Ortop Traumatol. 2012;<span class="elsevierStyleBold">56</span>;374–7.</p>" ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 845 "Ancho" => 1164 "Tamanyo" => 39035 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Gender distribution of patients included in the study.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1040 "Ancho" => 1303 "Tamanyo" => 84372 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Histological types found in patients. GCT, giant cell tumour; LEYSA, leiomyosarcoma; LIPSA, liposarcoma; MFH, malignant fibrous histiocytoma; SYNSA, synovial sarcoma.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 641 "Ancho" => 1141 "Tamanyo" => 32650 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Ratio between disease stages according to AJCC 2010 and groups of patients.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 866 "Ancho" => 1158 "Tamanyo" => 37882 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Location of sarcomas among patients included in the study. LL, lower limbs; UL, upper limbs.</p>" ] ] 4 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Cost (€) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Mean (€) \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diagnosis another centre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diagnosis another centre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7596.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">330.26 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Treatment another centre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Treatment another centre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diagnosis reference centre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diagnosis reference centre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46,908.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2039.48 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Treatment reference centre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Treatment reference centre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">197,488.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9404.19 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Overall cost \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Overall cost \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">248,192.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11,818.67 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab204537.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Costs of patients referred prior to biopsy.</p>" ] ] 5 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Cost (€) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Mean (€) \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diagnosis another centre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diagnosis another centre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48,204.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1785.33 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Treatment another centre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Treatment another centre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">124,496.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4610.96 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diagnosis reference centre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diagnosis reference centre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30,136.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1116.15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Treatment reference centre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Treatment reference centre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">242,096.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8966.52 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Overall cost \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Overall cost \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44,433.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16,456.74 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab204538.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 1 | 4 |
| 2024 October | 13 | 8 | 21 |
| 2024 September | 21 | 7 | 28 |
| 2024 August | 22 | 3 | 25 |
| 2024 July | 36 | 6 | 42 |
| 2024 June | 12 | 2 | 14 |
| 2024 May | 33 | 1 | 34 |
| 2024 April | 65 | 1 | 66 |
| 2024 March | 16 | 7 | 23 |
| 2024 February | 16 | 6 | 22 |
| 2024 January | 36 | 6 | 42 |
| 2023 December | 21 | 8 | 29 |
| 2023 November | 30 | 8 | 38 |
| 2023 October | 19 | 9 | 28 |
| 2023 September | 12 | 4 | 16 |
| 2023 August | 13 | 6 | 19 |
| 2023 July | 11 | 4 | 15 |
| 2023 June | 33 | 2 | 35 |
| 2023 May | 44 | 4 | 48 |
| 2023 April | 38 | 2 | 40 |
| 2023 March | 25 | 5 | 30 |
| 2023 February | 18 | 9 | 27 |
| 2023 January | 8 | 9 | 17 |
| 2022 December | 16 | 7 | 23 |
| 2022 November | 34 | 9 | 43 |
| 2022 October | 25 | 5 | 30 |
| 2022 September | 32 | 18 | 50 |
| 2022 August | 18 | 20 | 38 |
| 2022 July | 6 | 6 | 12 |
| 2022 June | 9 | 9 | 18 |
| 2022 May | 15 | 15 | 30 |
| 2022 April | 12 | 12 | 24 |
| 2022 March | 22 | 29 | 51 |
| 2022 February | 25 | 20 | 45 |
| 2022 January | 29 | 16 | 45 |
| 2021 December | 15 | 26 | 41 |
| 2021 November | 44 | 27 | 71 |
| 2021 October | 44 | 30 | 74 |
| 2021 September | 33 | 22 | 55 |
| 2021 August | 40 | 9 | 49 |
| 2021 July | 16 | 8 | 24 |
| 2021 June | 17 | 8 | 25 |
| 2021 May | 12 | 6 | 18 |
| 2021 April | 20 | 6 | 26 |
| 2021 March | 17 | 8 | 25 |
| 2021 February | 7 | 9 | 16 |
| 2021 January | 8 | 6 | 14 |
| 2020 December | 1 | 0 | 1 |
| 2018 February | 3 | 0 | 3 |
| 2018 January | 11 | 0 | 11 |
| 2017 December | 7 | 0 | 7 |
| 2017 November | 18 | 2 | 20 |
| 2017 October | 6 | 2 | 8 |
| 2017 September | 7 | 5 | 12 |
| 2017 August | 14 | 1 | 15 |
| 2017 July | 16 | 7 | 23 |
| 2017 June | 26 | 3 | 29 |
| 2017 May | 13 | 2 | 15 |
| 2017 April | 12 | 2 | 14 |
| 2017 March | 9 | 13 | 22 |
| 2017 February | 6 | 3 | 9 |
| 2017 January | 5 | 4 | 9 |
| 2016 December | 11 | 5 | 16 |
| 2016 November | 5 | 4 | 9 |
| 2016 October | 20 | 9 | 29 |
| 2016 September | 7 | 4 | 11 |
| 2016 August | 9 | 1 | 10 |
| 2016 July | 6 | 1 | 7 |
| 2016 June | 14 | 3 | 17 |
| 2016 May | 16 | 5 | 21 |
| 2016 April | 5 | 2 | 7 |
| 2016 March | 16 | 8 | 24 |
| 2016 February | 11 | 7 | 18 |
| 2016 January | 6 | 4 | 10 |
| 2015 December | 11 | 5 | 16 |
| 2015 November | 13 | 4 | 17 |
| 2015 October | 15 | 7 | 22 |
| 2015 September | 6 | 5 | 11 |
| 2015 August | 12 | 3 | 15 |
| 2015 July | 13 | 5 | 18 |
| 2015 June | 15 | 1 | 16 |
| 2015 May | 16 | 4 | 20 |
| 2015 April | 16 | 6 | 22 |
| 2015 March | 15 | 5 | 20 |
| 2015 February | 16 | 1 | 17 |
| 2015 January | 22 | 3 | 25 |
| 2014 December | 26 | 9 | 35 |
| 2014 November | 14 | 2 | 16 |
| 2014 October | 18 | 5 | 23 |
| 2014 September | 15 | 2 | 17 |
| 2014 August | 2 | 0 | 2 |
| 2014 June | 2 | 0 | 2 |
| 2014 May | 4 | 0 | 4 |
| 2013 July | 1 | 0 | 1 |
| 2013 June | 1 | 0 | 1 |
| 2013 May | 3 | 0 | 3 |
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