The Economic Burden of Vertigo: Results From the Hospitalized and Outpatients.

OBJECTIVE: Vertigo and dizziness are the common presenting concerns in emergency departments and outpatient clinics, accounts for approximately 15% to 20% of adults annually. We aimed to evaluate economic burden of vertigo on health-care system and work productivity in association between clinic characteristics of in- or outpatients. METHODS: A total number of 2289 patients diagnosed with peripheric (noncentral) vertigo were evaluated retrospectively. The direct medical costs associated with vertigo classified as medication, consumable, imaging, and laboratory. In addition, the indirect costs were associated with lost working days. The overall economic impact of vertigo assessed via total expenditure for diagnosis and treatment. RESULTS: The mean duration of hospitalization was 5.6 ± 4.3 days and working day lost was 9.47 ± 3.90 days. The overall impact on work productivity of disease was 15.35 ± 6.11 days. The overall mean direct cost including all expenditure items associated with vertigo care was $250.25 ± $1479.62 per patient. The overall cost associated with vertigo was found to be statistically increased in the male, aged ≥65 years, widow or divorced, and hospitalized patients. CONCLUSIONS: Our findings clearly indicate that a vertigo-dizziness management program based on patients' risk factors may achieve to reduce hospitalizations and cost of hospital care as well.

Vertigo and dizziness cause considerable more health care resource use and costs: results from the KORA FF4 study.

OBJECTIVES: Vertigo is a common reason for primary care consultations, and its diagnosis and treatment consume considerable medical resources. However, limited information on the specific cost of vertigo is currently available. The aim of this study is to analyse the health care costs of vertigo and examine which individual characteristics would affect these costs. STUDY DESIGN: We used cross-sectional data from the German KORA ("Cooperative Health Research in the Augsburg Region") FF4 study in 2013. METHODS: Impact of personal characteristics and other factors was modelled using a two-part model. Information on health care utilisation was collected by self-report. RESULTS: We included 2277 participants with a mean age of 60.8 (SD = 12.4), 48.4% male. Moderate or severe vertigo was reported by 570 (25.0%) participants. People with vertigo spent 818 Euro more than people without vertigo in the last 12 months (2720.9 Euro to 1902.9 Euro, SD = 4873.3 and 5944.1, respectively). Consultation costs at primary care physicians accounted for the largest increase in total health care costs with 177.2 Euro (p < 0.01). After adjusting for covariates, the presence of vertigo increased both the probability of having any health care costs (OR = 1.6, 95% CI =[1.2;2.4]) and the amount of costs (exp(ß) = 1.3, 95% CI = [1.1;1.5]). The analysis of determinants of vertigo showed that private insurance and a medium level of education decreased the probability of any costs, while higher income increased it. CONCLUSIONS: The presence of vertigo and dizziness required considerable health care resources and created significantly more related costs in different health care sectors for both primary and pertinent secondary care.

[What do MRI and CT scan provide us in patients with vertigo and dizziness? A cost-utility analysis]. / Que aporta la neuroimagen en pacientes con vertigo y mareo? Analisis coste-utilidad.

INTRODUCTION: Vertigo and dizziness are symptoms with a significant burden in the hospital and involve several specialties. There are few guidelines of radiological tests for these symptoms. AIMS: To know which profile of patients with vertigo and dizziness has neuroimaging tests, quantify and describe the radiological findings. To analyze the cost-utility of CT and MRI in the study of these patients. PATIENTS AND METHODS: Descriptive study, we selected patients referred to the hospital for vertigo and dizziness. We analyze demographic and clinical characteristics and quantify the neuroimaging tests requested. We describe the radiological findings, assess their relevance in the diagnosis and detail the cost-benefit. RESULTS: We identified 493 patients, those with neuroimaging test (60%) are older, depressed and frequented the emergency department because of vertigo. The most requested test was the cranial CT scan (5% identifies the cause of the symptom). MRI of the inner ear and cerebellopontine angle was the test that presented the most significant findings (17.7%). The 286 image tests requested for vertigo cost 56,741 euros. The cost for a positive test was 1,576 euros. CONCLUSIONS: A large number of head CT and MRI are made in patients with vertigo and dizziness. A clinical suspicion is recommended from the anamnesis and exploration to make a good selection of test to request. In more than 90% of cases, radiological findings are not shown in relation to vertigo.

TITLE: Que aporta la neuroimagen en pacientes con vertigo y mareo? Analisis coste-utilidad.Introduccion. Vertigo y mareo son sintomas que suponen una carga significativa en el hospital e involucran a varias especialidades. Existen pocas guias sobre la solicitud de pruebas radiologicas ante estos sintomas. Objetivos. Conocer que perfil de pacientes con vertigo y mareo tiene realizadas pruebas de neuroimagen, cuantificar y describir los hallazgos radiologicos, y analizar el coste-utilidad de la tomografia computarizada (TC) y la resonancia magnetica (RM) en pacientes con estos sintomas. Pacientes y metodos. Estudio descriptivo en el que se seleccionan pacientes remitidos al hospital por vertigo y mareo. Se analizan caracteristicas demograficas y clinicas y se cuantifican las pruebas de neuroimagen solicitadas. Se describen los hallazgos radiologicos, se valora su relevancia en el diagnostico y se detalla el coste. Resultados. Se identifica a 493 pacientes, el 60% tiene realizada una prueba de neuroimagen; son pacientes de mas edad, depresivos y que han acudido a urgencias por vertigo. La prueba mas realizada fue la TC de craneo sin contraste (el 5% identifica la causa del sintoma). La que presento mas hallazgos significativos fue la RM de la base del craneo (17,7%). Las 286 pruebas de imagen solicitadas por vertigo costaron 56.741 euros. El gasto para obtener un diagnostico radiologico fue de 1.576 euros. Conclusiones. Se realiza un gran numero de TC y RM de cabeza en pacientes con vertigo y mareo. Es recomendable tener un diagnostico de sospecha previo a partir de la anamnesis y la exploracion para hacer una buena seleccion de las pruebas que hay que solicitar. En mas del 90% de los casos no se muestran hallazgos radiologicos en relacion con el vertigo.

Cost-effective analysis of unilateral vestibular weakness investigation.

OBJECTIVES: To evaluate the cost-effectiveness of obtaining a magnetic resonance imaging (MRI) in patients with abnormal electronystagmography (ENG) or videonystagmography (VNG) results. STUDY DESIGN: Retrospective chart review. SETTINGS: Academic specialty center. PATIENTS: Patients presenting with vertigo between January 1, 2010, and August 30, 2013. METHODS: Patients who fit the following abnormal criteria were included in the study: unilateral caloric weakness (≥20%), abnormal ocular motor testing, and nystagmus on positional testing. Patients with abnormal findings who then underwent MRI with gadolinium were evaluated. RESULTS: Of the 1,996 charts reviewed, there were 1,358 patients who met the inclusion criteria. The average age of these patients was 62 years (12-94 yr). The male:female ratio was approximately 1:2. Of the 1,358 patients, 253 received an MRI with the following pathologies: four vestibular schwannomas, three subcortical/periventricular white matter changes suspicious for demyelinating disease, four acute cerebellar/posterior circulation infarct, two vertebral artery narrowing, one pseudomeningocele of internal auditory canal, and two white matter changes indicative of migraines. The positive detection rate on MRI was 5.5% based on MRI findings of treatable pathologies causing vertigo. Average cost of an MRI is $1,200, thereby making the average cost of identifying a patient with a positive MRI finding $15,180. CONCLUSION: In our study, those patients with a positive MRI had a constellation of symptoms and findings (asymmetric sensorineural hearing loss, tinnitus, vertigo, and abnormal ENG/VNG). Cost-effectiveness can be improved by ordering an MRI only when clinical examination and VNG point toward a central pathology. Clinical examination and appropriate testing should be factored when considering the cost-effectiveness of obtaining an MRI in patients with abnormal ENG/VNG findings.

Economic management of vertigo/dizziness disease in a county hospital: video-head-impulse test vs. caloric irrigation.

The video-head-impulse test (vHIT) is an important test for examining unilateral vestibular hypofunction. Alternatively, one can test for vestibular hypofunction with the caloric irrigation test. Various studies have shown that both tests may not always identify vestibular hypofunction; instead, the results of the tests might be contradictory. This retrospective study reproduces those finding in a much larger group of patients at a county hospital. 1063 patients were examined with the vHIT and bithermal caloric irrigation on the same day and analyzed with respect to side differences. Of those patients 13.3% had pathological vHIT and a caloric irrigation test, 4.6% a pathological vHIT only and 24.1% a pathologic caloric test only. As both tests might be necessary, we calculated the optimal sequence of the two examinations based on savings in time for the different disease groups. Especially in vestibular failure using the vHIT first and only applying the caloric irrigation in case of an unremarkable vHIT saves time and optimizes the diagnostic work up. In contrast, in Menière's disease and vestibular migraine testing caloric irrigation first might be more efficient.

Delayed diagnosis and treatment of benign paroxysmal positional vertigo associated with current practice.

The purposes of this study were to demonstrate the current status of benign paroxysmal positional vertigo (BPPV) management and the advantages of repositioning maneuvers as well as to facilitate the accurate and efficient diagnosis and management of BPPV. Of 131 participants with severe dizziness/vertigo who were examined and treated, 31 (23.7%) fulfilled the diagnostic criteria for BPPV. All patients in the study had a diagnosis of BPPV confirmed by their history, typical subjective symptom reports, and characteristic positional nystagmus during the Dix-Hallpike test and/or roll test. All participants were comprehensively interviewed regarding their medical history, characteristics of the first attack of vertigo, associated symptoms, previous financial costs, and number of hospital visits. The average duration from the appearance of the first symptoms until a final diagnostic positional maneuver was >70 months. On average, patients visited hospitals more than eight times before the final diagnosis due to initial visits to inappropriate departments, including neurology, emergency, orthopaedic surgery, and Traditional Chinese Medicine, with a corresponding average financial cost of more than 5,000 RMB. The canalith repositioning procedure (CRP) was effective in 80.65% of patients after the first repositioning maneuver. Our data demonstrated that despite the significant prevalence of BPPV, delays in diagnosis and treatment frequently occur, which have both cost and quality-of-life impacts on both patients and their caregivers. The CRP is very effective for patients with BPPV. It is important for patients to pay more attention to the impact of BPPV on their lives and recognize its nature to ensure compliant follow-up in otolaryngology.

Rising annual costs of dizziness presentations to U.S. emergency departments.

OBJECTIVES: Dizziness and vertigo account for roughly 4% of chief symptoms in the emergency department (ED). Little is known about the aggregate costs of ED evaluations for these patients. The authors sought to estimate the annual national costs associated with ED visits for dizziness. METHODS: This cost study of adult U.S. ED visits presenting with dizziness or vertigo combined public-use ED visit data (1995 to 2009) from the National Hospital Ambulatory Medical Care Survey (NHAMCS) and cost data (2003 to 2008) from the Medical Expenditure Panel Survey (MEPS). We calculated total visits, test utilization, and ED diagnoses from NHAMCS. Diagnosis groups were defined using the Healthcare Cost and Utilization Project's Clinical Classifications Software (HCUP-CCS). Total visits and the proportion undergoing neuroimaging for future years were extrapolated using an autoregressive forecasting model. The average ED visit cost-per-diagnosis-group from MEPS were calculated, adjusting to 2011 dollars using the Hospital Personal Health Care Expenditures price index. An overall weighted mean across the diagnostic groups was used to estimate total national costs. Year 2011 data are reported in 2011 dollars. RESULTS: The estimated number of 2011 US ED visits for dizziness or vertigo was 3.9 million (95% confidence interval [CI] = 3.6 to 4.2 million). The proportion undergoing diagnostic imaging by computed tomography (CT), magnetic resonance imaging (MRI), or both in 2011 was estimated to be 39.9% (39.4% CT, 2.3% MRI). The mean per-ED-dizziness-visit cost was $1,004 in 2011 dollars. The total extrapolated 2011 national costs were $3.9 billion. HCUP-CCS key diagnostic groups for those presenting with dizziness and vertigo included the following (fraction of dizziness visits, cost-per-ED-visit, attributable annual national costs): otologic/vestibular (25.7%; $768; $757 million), cardiovascular (16.5%, $1,489; $941 million), and cerebrovascular (3.1%; $1059; $127 million). Neuroimaging was estimated to account for about 12% of the total costs for dizziness visits in 2011 (CT scans $360 million, MRI scans $110 million). CONCLUSIONS: Total U.S. national costs for patients presenting with dizziness to the ED are substantial and are estimated to now exceed $4 billion per year (about 4% of total ED costs). Rising costs over time appear to reflect the rising prevalence of ED visits for dizziness and increased rates of imaging use. Future economic studies should focus on the specific breakdown of total costs, emphasizing areas of high cost and use that might be safely reduced.

The costs and utility of imaging in evaluating dizzy patients in the emergency room.

OBJECTIVES/HYPOTHESIS: To determine the usefulness and the costs of computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of patients with dizziness in the emergency department (ED). STUDY DESIGN: Retrospective chart review. METHODS: Charts of patients with a specific health maintenance insurance plan presenting with dizziness and vertigo to a large health system's ED between January 2008 and January 2011 were reviewed. Patient demographics, signs/symptoms, and CT and MRI results were assessed. CT and MRI charges were determined based on positive versus unremarkable findings. Data analysis included stepwise logistic regressions. RESULTS: Of 1681 patients identified, 810 (48%) received CT brain/head scan totaling $988,200 in charges. Of these, only 0.74% yielded clinically significant pathology requiring intervention. However, 12.2% of MRI studies yielded discovery of significant abnormalities. Logistic regression analysis revealed that older patients (P = .001) were more likely to receive a CT scan. CONCLUSIONS: In the 3-year period studied, CT scans for ED patients with dizziness and vertigo yielded a low predictive value for significant pathology. These data reveal a great opportunity for cost savings by developing stricter guidelines for ordering CT scans for this set of ED patients. The use of MRI in all cases of dizziness was found to be neither practical nor useful. However, appropriately directed MRI of the brain is recommended in patients with dizziness and other neurological signs or symptoms.

Frecuencia y pertinencia del perfil lipídico como examen inicial en vértigo periférico / Lipid profile frequency and relevancy as an initial test for peripheral vertigo

Objetivos Determinar la prevalencia de la solicitud del perfil lipídico como ayuda diagnóstica de primera línea en pacientes con impresión clínica de vértigo periférico, así como un análisis de la relación costo-beneficio de dicha solicitud. Métodos Estudio de tipo corte transversal retrospectivo. Revisión de 201 historias de pacientes atendidos en la consulta externa tanto de especialistas como de médicos generales de la Clínica Universitaria Teletón y Casa chía, con diagnóstico de vértigo periférico, en el periodo comprendido entre enero de 2005 y julio de 2008. Resultados Las edades de los pacientes oscilaron entre 6 y 87 años, el 36 % de sexo masculino y el 64 % femenino. El perfil lipídico fue solicitado como prueba diagnóstica inicial para el manejo de vértigo a un 76 % de los pacientes. Los perfiles lipídicos hallados fueron normales en el 80 % de los pacientes a quienes se les solicitó. Se presenta el análisis de la relación costo-beneficio de esta prueba. Conclusiones Existe una alta prevalencia de solicitud de perfil lipídico como estudio de primera línea en el abordaje de pacientes con vértigo periférico, aunque no existe evidencia que avale esta solicitud, se requiere retroalimentación al cuerpo médico tanto de atención primaria como especialistas.

Objective Determining the prevalence of requesting lipid profile as a first-line diagnostic method in patients having a clinical impression of peripheral vertigo and also determining such request's cost- benefit ratio. Methods This was a retrospective cross-sectional study of 201 clinical charts regarding patients diagnosed as having peripheral vertigo at the Teletón teaching hospital's outpatient services in Chía between January 2005 and July 2008. Clinical charts drawn up by both general practitioners and medical specialists at first-time visit were compiled and analyzed Results The patients were aged 6 to 87 years old; 36 % were males and 64 % females. Lipid profile was requested for 76 % of the patients as initial diagnostic method; it was found that 80 % of the results revealed no abnormality. Conclusion Although a high prevalence regarding a request for lipid profile first-line study was found for patients having peripheral vertigo, there was no scientific evidence supporting such requirement. Ordering this kind of study not only increases unnecessary costs concerning diagnostic methods but also involves unjustified treatment. Feedback is needed for both doctors and first attention staff to ensure that this type of practice becomes changed.

[Lipid profile frequency and relevancy as an initial test for peripheral vertigo]. / Frecuencia y pertinencia del perfil lipídico como examen inicial en vértigo periférico.

OBJECTIVE: Determining the prevalence of requesting lipid profile as a first-line diagnostic method in patients having a clinical impression of peripheral vertigo and also determining such request's cost- benefit ratio. METHODS: This was a retrospective cross-sectional study of 201 clinical charts regarding patients diagnosed as having peripheral vertigo at the Teletón teaching hospital's outpatient services in Chía between January 2005 and July 2008. Clinical charts drawn up by both general practitioners and medical specialists at first-time visit were compiled and analyzed. RESULTS: The patients were aged 6 to 87 years old; 36 % were males and 64 % females. Lipid profile was requested for 76 % of the patients as initial diagnostic method; it was found that 80 % of the results revealed no abnormality. CONCLUSION: Although a high prevalence regarding a request for lipid profile first-line study was found for patients having peripheral vertigo, there was no scientific evidence supporting such requirement. Ordering this kind of study not only increases unnecessary costs concerning diagnostic methods but also involves unjustified treatment. Feedback is needed for both doctors and first attention staff to ensure that this type of practice becomes changed.

Occupational disability caused by dizziness and vertigo: a register-based prospective study.

BACKGROUND: Despite the magnitude of dizziness/vertigo in primary health care, prospective studies are scarce, and few studies have focused on vocational consequences. Using the International Classification of Primary Health Care (ICPC), GPs have two alternative diagnoses, H82 (vertiginous syndrome) and N17 (vertigo/dizziness), when issuing sickness certificates to these patients. AIM: To assess the incidence of dizziness/vertigo in long-term sickness absence and to identify sociodemographic and diagnostic predictors for transition into disability pension. DESIGN OF STUDY: Register-based prospective study, 5-year follow-up. SETTING: All individuals in Norway eligible for sickness absence in 1997 (registered employed or unemployed). METHOD: The risk of disability pension was assessed with Cox proportional hazards analysis, with medical and sociodemographic information as independent variables, stratified for sex. RESULTS: Six-hundred and ninety-four women and 326 men were included. Dizziness/vertigo made up 0.9% of long-term sickness absence among women and 0.7% among men. Among both women and men, 41% was certified with H82 and 59% with N17: 23% of women and 24% of men obtained a disability pension. Age was the strongest predictor for obtaining a disability pension. Subjects with only basic education had an almost doubled risk of obtaining a disability pension compared to the highest educational group. Women with H82 had significantly higher risk for obtaining a disability pension than those with N17. The difference increased after adjustment for sociodemographic variables. Sex had no effect when all other variables were controlled for. CONCLUSION: Dizziness/vertigo is an infrequent cause of certified sickness absence, but long-term sickness absentees with dizziness/vertigo have a considerable risk of obtaining a disability pension in the future.

Primary assessment of the vertiginous patient at a pre-ENT balance clinic.

INTRODUCTION: Due to problems with long waiting times for assessment of vertiginous patients (more than 24 weeks), we changed practice and instituted a pre-ENT balance clinic assessment; we then audited the results. In particular, we looked at the subgroup with benign positional paroxysmal vertigo. METHODS: One hundred and fifteen patients were seen at the pre-ENT balance clinic from October 2003 to September 2004. Those diagnosed with benign positional paroxysmal vertigo received particle repositioning therapy at the same clinic and did not subsequently need ENT assessment. RESULTS: By the end of the audit period, waiting times were reduced to three weeks, and more than one-quarter of vertiginous patients (i.e. those diagnosed with benign positional paroxysmal vertigo) did not need to be reviewed at an ENT clinic. CONCLUSION: We believe this to be the first study to present prospective data showing that patients with benign positional paroxysmal vertigo may be safely diagnosed and effectively managed at a pre-ENT balance clinic.

Clinical examination of labyrinthine-defective patients out of the vertigo attack: sensitivity and specificity of three low-cost methods.

Many reports have appeared in the medical literature concerning the clinical examination at the bedside of patients with vertigo and, even if few controversial opinions exist, the observation of one or more kinds of nystagmus is generally regarded as suggesting an organic aetiology. So far, the presence of nystagmus has been generally considered to be crucially important for clinicians who are daily asked to differentiate between an "organic" cause of vertigo (for example, a labyrinthine dysfunction) and a "non-organic" cause of vertigo, such as a panic disorder. Albeit, it should not be forgotten that the central nervous system is able to resolve the asymmetry of vestibulo-ocular reflexes, due to a peripheral vestibular failure, by means of compensatory mechanisms so that nystagmus is rapidly abolished after the acute attack of vertigo. In addition, visual fixation elicits sub-cortical inhibitory pathways to the vestibular nuclei so that spontaneous nystagmus is remarkably reduced by light. In order to more easily detect nystagmus, attempts have been made to minimize the interference of visual fixation by means of positive lenses (Frenzel's glasses) and light occluding masks with infrared cameras (videonystagmoscopy) which have in part replaced direct observation of the patient's eyes, albeit no systematic validation of the advantages has been reported yet. To investigate the usefulness of these 3 low-cost methods to detect nystagmus, 528 outpatients presenting peripheral vestibular hypofunction, diagnosed by a complete audiological and vestibular examination, including caloric tests, were enrolled in the present study, while 133 subjects with normal vestibular function acted as a control group. All patients and control subjects underwent a standardized clinical examination based on search for spontaneous, positioning and head-shaking nystagmus detected by direct observation of patient's eyes, Frenzel's glasses and videonystagmoscopy. Specificity of the three techniques were 35.6, 43.7 and 91.6, whilst sensitivity was 88.7, 88.7 and 84.2, respectively. Finally, discriminant analysis based on the presence/absence of at least one kind of nystagmus was computed for each technique and showed that videonystagmoscopy allowed the examiner to correctly classify both pathological and normal subjects more frequently (> 77% of cases) than the other two methods (about 50%). It is concluded that only videonystagmoscopy is an acceptable technique for screening a labyrinth defect in a population of outpatients with vertigo.

Do patients with benign paroxysmal positional vertigo receive prompt treatment? Analysis of waiting times and human and financial costs associated with current practice.

This study retrospectively analysed how 20 patients with posterior canal benign paroxysmal positional vertigo (BPPV) were managed from primary care, to treatment in tertiary care. The average time from first referral to treatment was 93 weeks, with an average of 58 weeks within primary care and 40 weeks within hospital care. At least 85% of cases had classical symptoms of BPPV and could have been easily identified by Primary Care Physicians at first referral, had they been trained to recognise and diagnose the condition. It was concluded that patients could be treated more efficiently and at less cost if the condition was identified at first referral in primary care, and treated in either primary care or dedicated BPPV clinics receiving referrals from primary care. A dedicated clinic for BPPV is recommended, which will substantially reduce waiting time for treatment and save primary care and hospitals time and money by avoiding unnecessary appointments and medication.

[Vestibular dysfunction after cochlear implantation: a national multicenter clinical study]. / Vertiges et troubles de l'equilibre après implantation cochléaire. Analyse préliminaire des données du PHRC national: "Diffusion de la technique des implants cochléaires: etude d'impact des conséquences médicales, sociales et economiques".

Vertigo and dizziness are the most common complications of cochlear implantation. Data of a multicentric study about clinical aspects and cost utility were collected for vertigo and dizziness: incidence, clinical and treatment were analyzed among 469 adults and children. Results demonstrated that 16% of adults and 3% of children experienced dizziness postoperatively. In a few cases a specific mechanism as perilymphatic fistula was identified. In other cases the mechanism underlying delayed vertigo remains speculative and endolymphatic hydrops was suggested.

[Delayed diagnosis of benign paroxysmal vertigo: economic impact]. / Il ritardo diagnostico nella vertigine posizionale parossistica benigna: impatto economico.

Some time has passed since the early 1980's when a group of vestibologists with the same singular passion introduced in Italy the concept of Paroxysmal Positional Vertigo (PPV). Since then great advances have been made, but, despite the energy focused on improving and expanding the knowledge on this common disorder, PPV still frequently goes unrecognized. The direct consequence of delayed diagnosis is prolonged patient discomfort and the execution of useless, costly clinical examinations. Today, in most cases, delayed diagnosis is unjustified. Within the modern concept of health care economics, such delay is costly to the health care provider and has obvious psycho-physical repercussions for the patient who has to undergo a fruitless series of examinations and treatments of all types without reaping any benefits. In this light the Authors have performed a study to identify and quantify the relative costs of the most common errors made in the diagnosis of PPV. For a sample population of 100 patients, the clinical-instrumental tests performed before the disorder was correctly diagnosed were gathered and analyzed. Then the costs for the management of PPV patients diagnosed late were compared with those for patients whose diagnosis was reached early on. The results indicate that for each delay in PPV diagnosis the average cost was Euro 317.66 vs. Euro 64.04 for early diagnosis: a difference of Euro 253.06. The Authors underline how in this brief period of time (March-September 2000) the prescription of excessive testing led to a significant waste of money (Euro 10137.01).

Cost-effectiveness of the diagnostic evaluation of vertigo.

OBJECTIVE: To evaluate the cost-effectiveness of several diagnostic tests used in the evaluation of vertigo. STUDY DESIGN: Cost-effectiveness analysis, using data from retrospective case review. METHODS: Charts and test results were reviewed from 192 outpatients seen in an academic tertiary referral center for evaluation of vertigo. Cost-effectiveness analysis was performed using decision analysis software, data from office and hospital charges, and expert-based estimations of the utility of different test outcomes. Sensitivity analysis was performed using standard algorithms and wide variable ranges. RESULTS: We found that audiologic testing, posturography, and electronystagmography were the most cost-effective tests, and that magnetic resonance imaging and blood tests had the lowest cost-effectiveness. The analysis was sensitive to the effects of financial costs of tests but, with a few exceptions, was typically not sensitive to the utility of test outcomes or the distribution of test results. CONCLUSIONS: The use of cost-effectiveness analysis, the estimation of utility of test outcomes, and techniques of sensitivity analysis should help guide the clinician's decision making on appropriate testing for patients with vertigo.