The costs and savings of the TMA technology
Constructing a TMA has additional costs, on top of the cost of manufacturing each single donor block.
In order to calculate all the costs of the products of an Histopathology Laboratory we created an Excel file calculator in which all the costs are factured in. The reference is the year 2011 and the Lab is the San Gerardo Hospital Department of Pathology.
Note that the net Technician pay and the indirect costs of the Hospital (insurance, overhead, state taxes) are calculated separately. No professional cost is included.
The Excel calculator can be downloaded at the "Tariffs" page of this website.
One Hematoxylin and Eosin (H&E) stained slide, starting from an unfixed average specimen, costs approx. €25; 75% of this cost is labor.
Doing an immunostain (IHC) on a blank re-cut of the same block adds approx. €37.5, bringing the whole cost of the two to approx. €62.
The cost of labor for the IHC is down to 37%, because of automation.
You can download a PDF file with all the costs at this link.
To calculate the costs of producing a TMA, the calculator factors in all the variables (TMA design, replicas, random sampling, etc.). The calculation shown here are for average variables and for two scenarios: 10 cases or 75 cases, all in duplicate cores.
Creating an average 20-cores, 10 cases TMA costs €66, 95% of them labor. To generate a 150-cores, 75 cases TMA, the cost is €225.
For each single case, this adds €6.6 and €3 per case, respectively, a fraction of the additional cost for an IHC.
Cutting a TMA section and staining for an IHC stain will bring the cost for each single case, including the TMA manufacturing cost, to approx. €11 in the case of 10-cases TMA, and to €3.6 in the 75-cases TMA. A saving of a third in the first or of ten times in the latter.
Similar calculations have been published previously. See e.g. Thomson, T. A., et al. Am J Clin Pathol 132, 899905 (2009).
Using the TMA technology in a diagnostic setting has the potential of considerable savings for the National Health System by enhancing the appropriateness of costly individualized tumor therapy and by allowing mass screening for e.g. genetic traits for congenital tumor syndrome (e.g. Lynch syndrome or BRCA-1 deficiency).
Dr. Giorgio Bovo (Dept. of Pathology, San Gerardo Hospital) demonstrated this in his master thesis.