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1.
J Endocrinol Invest ; 43(11): 1645-1654, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32307641

RESUMEN

OBJECTIVES: A trial-based comparison of the use of resources, costs and health utility outcomes of fine-needle aspiration cytology (FNAC), and watchful observation for incidental small (< 2 cm) thyroid nodules was performed using data from the randomized controlled trial (RCT). METHODS: Using data from 314 patients, healthcare-related use of resources, costs, health utility, and quality-adjusted life years (QALYs) were estimated at 12 months after first presentation of incidental thyroid nodule(s) on an intention-to-treat basis with adjustment for covariates. Uncertainty about the incremental cost-effectiveness ratio for FNAC versus watchful management at 12 months of follow-up was incorporated using bootstrapping. Multiple imputation methods were used to deal with missing data. RESULTS: FNAC management was associated with greater use of healthcare resources and mean direct healthcare costs per patient (US$542.47 vs US$411.55). Lower mean 12-month QALYs per patient in FNAC was observed in comparison to watchful observation (0.752 versus 0.758). The probability that FNAC management was cost-effective compared with watchful management at a willingness-to-pay threshold of US50,000 per QALY gained was 26.5%. CONCLUSION: Based on 12-month data from RCT, watchful observation appeared cost-saving compared to FNAC in patients with incidental thyroid nodules that have a low-suspicion sonographic pattern and measure between 1.0 and 2.0 cm from healthcare provider perspective. CLINICALTRIALS. GOV IDENTIFIER: NCT02398721.


Asunto(s)
Citodiagnóstico/economía , Nódulo Tiroideo/terapia , Espera Vigilante/economía , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja Fina/economía , Biopsia con Aguja Fina/estadística & datos numéricos , China/epidemiología , Análisis Costo-Beneficio , Citodiagnóstico/métodos , Citodiagnóstico/estadística & datos numéricos , Femenino , Costos de la Atención en Salud/estadística & datos numéricos , Recursos en Salud/economía , Recursos en Salud/estadística & datos numéricos , Humanos , Hallazgos Incidentales , Masculino , Persona de Mediana Edad , Nódulo Tiroideo/economía , Nódulo Tiroideo/epidemiología , Nódulo Tiroideo/patología , Espera Vigilante/estadística & datos numéricos
2.
Horm Metab Res ; 47(11): 833-8, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-26267327

RESUMEN

Identification of germline mutation in patients with apparently sporadic pheochromocytomas and paragangliomas is crucial. Clinical indicators, which include young age, bilateral or multifocal, extra-adrenal, malignant, or recurrent tumors, predict the likelihood of harboring germline mutation in Caucasian subjects. However, data on the prevalence of germline mutation, as well as the applicability of these clinical indicators in Chinese, are lacking. We conducted a cross-sectional study at a single endocrine tertiary referral center in Hong Kong. Subjects with pheochromocytomas and paragangliomas were evaluated for the presence of germline mutations involving 10 susceptibility genes, which included NF1, RET, VHL, SDHA, SDHB, SDHC, SDHD, TMEM 127, MAX, and FH genes. Clinical indicators were assessed for their association with the presence of germline mutations. Germline mutations, 2 being novel, were found in 24.4% of the 41 Chinese subjects recruited and 11.4% among those with apparently sporadic presentation. The increasing number of the afore-mentioned clinical indicators significantly correlated with the likelihood of harboring germline mutation in one of the 10 susceptibility genes. (r=0.757, p=0.026). The presence of 2 or more clinical indicators should prompt genetic testing for germline mutations in Chinese subjects. In conclusion, our study confirmed that a significant proportion of Chinese subjects with apparently sporadic pheochromocytoma and paraganglioma harbored germline mutations and these clinical indicators identified from Caucasians series were also applicable in Chinese subjects. This information will be of clinical relevance in the design of appropriate genetic screening strategies in Chinese populations.


Asunto(s)
Neoplasias de las Glándulas Suprarrenales/genética , Pueblo Asiatico/genética , Predisposición Genética a la Enfermedad , Paraganglioma/genética , Feocromocitoma/genética , Adulto , China , Mutación de Línea Germinal/genética , Humanos , Persona de Mediana Edad , Curva ROC
3.
Eur J Surg Oncol ; 41(6): 758-65, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-25680952

RESUMEN

BACKGROUND: Rapid rise in differentiated thyroid cancer (DTC) may impose a heavy economic burden on future healthcare. We aimed to calculate the average first-year monetary cost/patient for DTC and estimate the projected cost burden on our local healthcare system. METHODS: Medical records of 270 clinically-relevant DTC patients were reviewed to calculate the amount of services utilized during the first-year. Only direct costs were included with estimates derived from government gazette. Cancer incidences were derived from the territory-wide cancer registry. Total annual cost equaled to the incidence multiplied by the cost/patient. RESULTS: The average first-year cost of DTC was USD11,560/patient. Initial surgery accounted for 66.9% of total cost. Male and female annual percentage increases for DTC were 4.86% and 4.28%, respectively. Female DTC is projected to surpass rectal cancer in 2019 (20.4/100,000 vs. 20.0/100,000) and colon cancer (47.2/100,000 vs. 46.8/100,000) in 2039. However, the projected incidence of DTC in 2026 would still be about one fourth that of CRC (19.5/100,000 vs. 83.2/100,000). CONCLUSIONS: The average first-year monetary cost of DTC care was relatively low. Initial surgery accounted for most of the cost. Despite a rapid incidence rise, the projected first-year cost for DTC is unlikely to impose substantial economic burden on our local future healthcare system.


Asunto(s)
Costos de la Atención en Salud/estadística & datos numéricos , Servicios de Salud/economía , Neoplasias de la Tiroides/economía , Adulto , Anciano , Costos Directos de Servicios , Femenino , Servicios de Salud/estadística & datos numéricos , Hong Kong/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Sistema de Registros , Factores Sexuales , Neoplasias de la Tiroides/epidemiología , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/terapia , Tiroidectomía/economía
4.
Br J Surg ; 91(4): 444-9, 2004 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-15048744

RESUMEN

BACKGROUND: Use of laparoscopy in patients with gastrointestinal cancer has been associated with port-site and peritoneal tumour metastases. The effect of laparoscopy on tumour recurrence and long-term survival in patients undergoing resection of ruptured hepatocellular carcinoma (HCC) remains unknown. METHODS: Between June 1994 and December 2001, 59 patients with ruptured HCC underwent surgical exploration with a view to hepatic resection. Laparoscopy with laparoscopic ultrasonography was performed in 33 patients; the other 26 patients underwent exploratory laparotomy without laparoscopy. Perioperative and long-term outcomes were compared between the two groups. RESULTS: Exploratory laparotomy was avoided in 12 of 13 patients with irresectable HCC who had a laparoscopy. The hospital stay of these 12 patients was significantly shorter than that of eight patients found to have irresectable HCC at exploratory laparotomy (median 11 versus 15 days; P = 0.043). Twenty patients had a laparoscopy followed by open resection of HCC, whereas 18 patients underwent laparotomy and resection without laparoscopy. There were no significant differences in disease-free (16 versus 19 per cent; P = 0.525) and overall (32 versus 48 per cent; P = 0.176) survival at 3 years between the two groups. The tumour recurrence pattern was similar between the two groups, and there were no port-site or wound metastases. CONCLUSION: Use of diagnostic laparoscopy in patients with ruptured HCC helps avoid unnecessary exploratory laparotomy. The present data suggest that laparoscopy does not have an adverse effect on tumour recurrence or survival in patients who undergo resection.


Asunto(s)
Carcinoma Hepatocelular/cirugía , Hepatectomía/métodos , Laparoscopía/métodos , Neoplasias Hepáticas/cirugía , Adulto , Anciano , Carcinoma Hepatocelular/mortalidad , Femenino , Hepatectomía/mortalidad , Humanos , Laparoscopía/mortalidad , Neoplasias Hepáticas/mortalidad , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/prevención & control , Estudios Retrospectivos , Rotura Espontánea , Análisis de Supervivencia
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