Effects of price information on test ordering in an intensive care unit.

OBJECTIVE: To determine if daily information on the price of common laboratory tests and chest X-ray could significantly influence test ordering by physicians and decrease the costs. DESIGN: A prospective observational and sequential study. SETTING: A 21-bed surgical intensive care unit of a university hospital. PATIENTS: All patients admitted during a 4-month period. INTERVENTIONS: A 2-month period served as control (period I). During a consecutive 2-month period (period II) physicians were informed about the costs of seven common diagnostic tests (plasma and urinary electrolytes, arterial blood gases, blood count, coagulation test, liver function test and chest X-ray). The number of tests ordered and costs during the two periods were compared. MEASUREMENTS AND RESULTS: A total of 287 patients were included (128 in period I and 159 in period II). Information about age, gender, Severe Acute Physiologic Score II, McCabe score, intensive care unit length of stay and mortality were collected and were not statistically different between the two study periods. Except for liver function tests, all the tests evaluated were less frequently prescribed when physicians were aware of the charges, irrespective of whether the tests were routine or requested during an emergency. Nevertheless, a significant reduction was obtained only for arterial blood gases and urinary electrolytes. Overall analysis of the expenditures (in Euros) showed a significant 22% decrease in period II (341+/-500 versus 266+/-372 Euros, p<0.05). CONCLUSION: Providing price information to physicians was associated with a significant reduction for arterial blood gases and urinary electrolytes tests ordered and was significantly cost-saving.

Cost-effectiveness of colorectal cancer screening with computed tomography colonography or fecal blood tests.

OBJECTIVE: To assess the cost-effectiveness of colorectal cancer screening using computed tomography colonography (CTC) and immunological fecal occult blood test (iFOBT). METHODS: CTC and iFOBT strategies were compared with Nn screening or guaiac FOBT (gFOBT) using Markov modeling. CTC was proposed at 50, 60, and 70 years, whereas gFOBT and iFOBT were performed every 2 years beginning at 50 years until 74 years of age with a 30-year time horizon. We calculated incremental cost-effectiveness ratios and efficiency ratios (ERs). Then, we performed univariate and probabilistic sensitivity analyses. RESULTS: With gFOBT as reference, colorectal cancer prevention rate was 18% for CTC and 11% for iFOBT. The incremental cost-effectiveness ratio of CTC and iFOBT were respectively 3204 and 5458 euro per life years gained (LYG), the ER for CTC was 0.22 and the ER for iFOBT was 2.08 colonoscopies per LYG. Cost-effectiveness results were sensitive to CTC cost. In the probabilistic sensitivity analysis, compared with CTC, iFOBT strategy was cost-effective for 84.6% of simulations when we assumed a willingness to pay (WTP) of 20,000 euro/LYG. CONCLUSION: CTC requires substantially less colonoscopies than iFOBT and is cost-effective for low values of WTP. However, iFOBT is the preferred screening strategy for a WTP greater than 6207 euro/LYG.

Cost-effectiveness of colorectal cancer screening with computed tomography colonography according to a polyp size threshold for polypectomy.

OBJECTIVE: Computed tomography colonography (CTC) has an acceptable accuracy in detecting colonic lesions, especially for polyps at least 6 mm. The aim of this analysis is to determine the cost-effectiveness of population-based screening for colorectal cancer (CRC) using CTC with a polyp size threshold. METHODS: The cost-effectiveness ratios of CTC performed at 50, 60 and 70 years old, without (PL strategy) or with (TS strategy) polyp size threshold were compared using a Markov process. Incremental cost-effectiveness ratios (ICER) were calculated per life-years gained (LYG) for a time horizon of 30 years. RESULTS: The ICER of PL and TS strategies were 12 042 and 2765 euro/LYG associated to CRC prevention rates of 37.9 and 36.5%. The ICER of PL and TS strategies dropped to 9687 and 1857 euro/LYG when advanced adenoma (AA) prevalence increased from 6.9 to 8.6% for male participants and 3.8-4.9% for female participants or to 9482 and 2067 euro/LYG when adenoma and AA annual recurrence rates dropped to 3.2 and 0.25%. The ICER for PL and TS strategies decreased to 7947 and 954 euro/LYG or when only two CTC were performed at 50 and 60-years-old. Conversely, the ICER did not significantly change when varying population participation rate or accuracy of CTC. CONCLUSION: CTC with a 6 mm threshold for polypectomy is associated to a substantial cost reduction without significant loss of efficacy. Cost-effectiveness depends more on the AA prevalence or transition rate to CRC than on CTC accuracy or screening compliance.