Circulating tumor DNA (ctDNA) is a promising new biomarker with multiple potential applications in cancer care. As part of the “ctDNA on the way to implementation in the Netherlands (COIN)” project, an early, comprehensive Health Technology Assessment (HTA) is ongoing. Information about the costs of ctDNA testing is essential for implementation. Estimating the total cost associated with ctDNA-testing is challenging due to variation in the workflow, wide range in purchase and operational costs of the platforms, and the highly dynamic field. As a first step in the HTA, the aim of this study was to develop a flexible micro-costing framework and open-access model for consistent cost calculation of ctDNA-testing.

First, the complete diagnostic workflow of ctDNA-testing was mapped based on expert discussions. This step-wise workflow was used as the foundation of the framework. Second, the activity-based costing method was used and included costs for personnel, materials, equipment, overhead, housing, and test failures. Third, the framework was validated by experts and by applying the cost calculation model to six case studies.

The diagnostic workflow was mapped from blood sample collection to reporting the diagnostic findings. The framework was developed from a Dutch perspective and takes into account the testing volume. The total cost per sample for the case studies with different workflows and testing volumes ranged from EUR 168 to EUR 7,638.

The developed micro-costing framework can be used to calculate the costs for ctDNA-testing for different workflows. The results from the case studies show the wide range of costs for ctDNA-testing and that the costs are determined by the choice of platform, setting, and testing volume. The open access model allows users to adapt and specify parameters in the diagnostic workflow matching their setting and can be used to support investment decisions and future cost-effectiveness studies.

Recently, blunt 18-gauge (ga) metal cannulae have become nationally commercially available as safety products. The ability of these blunt cannulae to prevent needlestick injury and to enable direct access of all standard latex ports and vial membranes, thus eliminating hypodermic needles entirely from the intravenous (IV) drug administration process, is assessed.

In the laboratory setting, the needlestick injury potential of small-bore blunt cannulae versus hypodermic needles was studied using blinded and randomized methods. Insertion force requirements were studied for cannulae and needles. Metal 18-ga blunt cannulae were inserted into four brands of standard Y-ports and vial stoppers to assess postpuncture integrity and force requirements.

Needlestick injury did not occur using small-bore blunt cannulae (P<.001; n=51). Metal 18-ga cannulae passed into prepierced standard Y-ports as easily as hypodermic needles and without loss of Y-port integrity. Insertion of metal 18-ga cannulae without prior port puncture was possible, but was associated with substantial coring and loss of integrity of the port seal, except for IVAC brand ports (P<.03).

Metal 18-ga cannulae can be inserted through virtually all intact standard rubber vial membranes or standard Y-ports to allow safe IV access. A single prepuncture of any standard latex membrane allows economical blunt metal cannula access equally efficiently as with expensive pre-slit membranes and without loss of membrane integrity.