Table 3.
Average and Incremental Costs of Telephone Versus In-Person Genetic Counseling and Testing
| Variable | UC |
TC |
Incremental Cost (TC v UC) | ||
|---|---|---|---|---|---|
| Time (minutes) | $ | Time (minutes) | $ | ||
| Initial counseling | |||||
| Staff costs | |||||
| Ancillary personnel (scheduling/administration @ $20.50 per hour)* | 32 | 10.90 | 32 | 10.90 | — |
| Counselor preparation @ $43.60 per hour* | 62 | 45.00 | 62 | 45.00 | — |
| Counseling @ $43.60 per hour* | 76 | 55.10 | 64 | 46.50 | −8.60 |
| Patient costs | |||||
| Round-trip travel @ $22.80 per hour* | 70 | 26.60 | — | — | −26.60 |
| Gasoline + parking† | 15.10 | — | — | −15.10 | |
| Time for initial counseling session* | 76 | 28.80 | 64 | 24.30 | −4.50 |
| Subtotal: initial session | 181.50 | 126.80 | −54.70 | ||
| Testing and disclosure | |||||
| Staff costs | |||||
| Ancillary personnel (scheduling and administration @ $21.90 per hour)* | 15 | 5.10 | 15 | 5.10 | — |
| Counselor preparation @ $44.30 per hour* | 74 | 53.80 | 74 | 53.80 | — |
| Post-test counseling @ $44.30 per hour* | 28 | 20.60 | 24 | 17.20 | −3.40 |
| Round-trip travel: disclosure @ $22.20 per hour* | 70 | 26.60 | — | — | −26.60 |
| Patient costs | |||||
| Gasoline + parking: disclosure† | 15.10 | — | −15.10 | ||
| Round-trip travel for blood draw @ $22.20 per hour* | — | — | 70 | 26.60 | 26.60 |
| Gasoline + parking for blood draw† | — | — | 15.10 | 15.10 | |
| Time for disclosure @ $22.80 per hour* | 28.4 | 10.80 | 23.7 | 9.00 | −1.80 |
| Time for blood draw* | 15 | 5.70 | 15 | 5.70 | — |
| Testing costs | |||||
| Gene sequencing charge‡ | 3,340.00 | 3,340.00 | — | ||
| Blood draw by phlebotomist @ $17.20 per hour* | 10 | 2.90 | 10 | 2.90 | — |
| Phlebotomy materials | 1.00 | 1.00 | — | ||
| Subtotal: testing + disclosure | 3,481.50 | 3,476.30 | −5.20 | ||
| Overhead | |||||
| Office space @ $38.60/sq ft§ (assume 50% of space for telephone counseling) | 110.90 | 55.50 | −55.50 | ||
| Telephone costs‖ (counseling only) | — | 0.96 | 0.96 | ||
| Subtotal: overhead | 110.90 | 56.40 | −54.50 | ||
| Total per patient | 3,774.00 | 3,660.00 | −114.40 | ||
Abbreviations: TC, telephone genetic counseling; UC, usual care (standard in-person genetic counseling).
Cost for genetic counselors' time is based on the national average of salary plus fringe benefit rate of $83,712 per year from 2010 data and adjusted for inflation to estimate 2012 salaries.30–33 The costs of ancillary personnel, patients, and phlebotomists are based on women's earnings from Current Population Survey plus fringe benefit rates31,33 adjusted to 2012 dollars.30 The median average wage and fringe benefit rates for patients, phlebotomists, and ancillary personnel were $22.80, $17.20, and $20.50 per hour, respectively, in 2012 dollars.
Average round-trip mileage for counseling is 43.7 miles (approximately 70 minutes). The standard mileage rate is $0.23 per mile for use of an automobile for medical care.34
We assume all patients receive comprehensive BRCA analysis from Myriad Genetic Laboratories. This assumption is made to isolate any differential costs of counseling related to TC v UC.
New and returning patients are 6 and 2.7 patients per week, respectively, for an estimated 34.8 per month.32 National average office rental rate is $38.60/sq ft,35 and we assume average medical office space is 100 sq ft. Thus, office space cost per patient is $38.60 × 100/34.8 patients = $110.90 per patient.
The phone cost of landline per patient is calculated by the genetic counselors' monthly patient volume: 34.8/per month32 and monthly phone rate of $33.40/month.