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1.
Int J Cancer ; 146(3): 781-790, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30977121

RESUMO

Bronchoscopy is the safest procedure for lung cancer diagnosis when an invasive evaluation is required after imaging procedures. However, its sensitivity is relatively low, especially for small and peripheral lesions. We assessed benefits and costs of introducing a bronchial gene-expression classifier (BGC) to improve the performance of bronchoscopy and the overall diagnostic process for early detection of lung cancer. We used discrete-event simulation to compare clinical and economic outcomes of two different strategies with the standard practice in former and current smokers with indeterminate nodules: (i) location-based strategy-integrated the BGC to the bronchoscopy indication; (ii) simplified strategy-extended use of bronchoscopy plus BGC also on small and peripheral lesions. Outcomes modeled were rate of invasive procedures, quality-adjusted-life-years (QALYs), costs and incremental cost-effectiveness ratios. Compared to the standard practice, the location-based strategy (i) reduced absolute rate of invasive procedures by 3.3% without increasing costs at the current BGC market price. It resulted in savings when the BGC price was less than $3,000. The simplified strategy (ii) reduced absolute rate of invasive procedures by 10% and improved quality-adjusted life expectancy, producing an incremental cost-effectiveness ratio of $10,109 per QALY. In patients with indeterminate nodules, both BGC strategies reduced unnecessary invasive procedures at high risk of adverse events. Moreover, compared to the standard practice, the simplified use of BGC for central and peripheral lesions resulted in larger QALYs gains at acceptable cost. The location-based is cost-saving if the price of classifier declines.


Assuntos
Análise Custo-Benefício , Detecção Precoce de Câncer/normas , Neoplasias Pulmonares/diagnóstico , Idoso , Biomarcadores Tumorais/genética , Biópsia/efeitos adversos , Biópsia/economia , Biópsia/normas , Brônquios/diagnóstico por imagem , Brônquios/patologia , Broncoscopia/efeitos adversos , Broncoscopia/economia , Broncoscopia/normas , Simulação por Computador , Redução de Custos , Detecção Precoce de Câncer/economia , Detecção Precoce de Câncer/métodos , Feminino , Seguimentos , Perfilação da Expressão Gênica/economia , Perfilação da Expressão Gênica/normas , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Anos de Vida Ajustados por Qualidade de Vida , Sensibilidade e Especificidade , Padrão de Cuidado/economia , Tomografia Computadorizada por Raios X/efeitos adversos , Tomografia Computadorizada por Raios X/economia , Tomografia Computadorizada por Raios X/normas
3.
PLoS One ; 14(4): e0215279, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30990840

RESUMO

A recent study showed that the Prostate Health Index may avoid unnecessary biopsies in men with prostate specific antigen 4-10ng/ml and normal digital rectal examination in the diagnosis of prostate cancer in Hong Kong. This study aimed to conduct an economic evaluation of the impact of adopting this commercially-available test in the Hong Kong public health service to determine whether further research is justified. A cost-consequence analysis was undertaken comparing the current diagnostic pathway with a proposed diagnostic pathway using the Prostate Health Index. Data for the model was taken from a prospective cohort study recruited at a single-institution and micro-costing studies. Using a cut off PHI score of 35 to avoid biopsy would cost HK$3,000 and save HK$7,988 per patient in biopsy costs and HK$511 from a reduction in biopsy-related adverse events. The net cost impact of the change was estimated to be HK$5,500 under base case assumptions. At the base case sensitivity and specificity for all grades of cancer (61.3% and 77.5% respectively) all grade cancer could be missed in 4.22% of the population and high grade cancer in 0.53%. The introduction of the prostate health index into the diagnostic pathway for prostate cancer in Hong Kong has the potential to reduce biopsies, biopsy costs and biopsy-related adverse events. Policy makers should consider the clinical and economic impact of this proposal.


Assuntos
Exame Retal Digital/economia , Antígeno Prostático Específico/sangue , Próstata , Neoplasias da Próstata , Idoso , Biópsia/economia , Análise Custo-Benefício , Hong Kong , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Próstata/metabolismo , Próstata/patologia , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/economia
4.
Int J Dermatol ; 58(11): 1317-1322, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31006848

RESUMO

BACKGROUND: Potassium hydroxide preparations (KOH) and tissue examinations for ova and parasites (O&P) are cost-effective office-based tests. No studies have quantified their utilization and economic impact. METHODS: The objective is to determine the billing patterns and costs of office-based diagnostic procedures in the Medicare population. We conducted a cross sectional study using the Part B National Summary Data File (2000-2016) and the Physician and Other Supplier Public Use File (2012-2015) released by the Centers for Medicare & Medicaid Services. RESULTS: In 2016, the total number of claims among all providers was 28,432 (KOH) and 52,182 (O&P), representing a decrease since 2000 (KOH, -41.8%; O&P, -43.4%). The total claims for in-office procedures by dermatologists per 10,000 beneficiaries decreased between 2012 and 2015 (KOH, -18.8%; O&P, -26.6%). Fewer dermatologists submitted claims for the tests (KOH, -11.3%; O&P, -16.6%). The total single (SB) and multiple (MB) biopsy claims by dermatologists per 10,000 beneficiaries decreased between 2012 and 2015 (SB, -1.8%; MB, -2.7%). The 2016 aggregate payments (% change since 2000) for KOH and O&P were $163,127.75 (-60.4%) and $299,074.18 (-61.6%), respectively; for SB and MB, they were $240,047,487.98 (+142.3%) and $38,214,117.22 (+79.2%), respectively. CONCLUSION: Fewer dermatologists submit claims for KOH and O&P each year. Future studies should evaluate whether this is due to a loss of cost-efficacy, and secondly, if it is related to decreased reimbursement, burdensome in-office laboratory regulations, or changing provider preferences.


Assuntos
Medicare/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Dermatopatias Parasitárias/diagnóstico , Biópsia/economia , Biópsia/estatística & dados numéricos , Técnicas de Laboratório Clínico/economia , Técnicas de Laboratório Clínico/estatística & dados numéricos , Estudos Transversais , Dermatologia/economia , Dermatologia/estatística & dados numéricos , Humanos , Hidróxidos/economia , Indicadores e Reagentes , Medicare/economia , Visita a Consultório Médico/economia , Compostos de Potássio/economia , Utilização de Procedimentos e Técnicas/economia , Pele/parasitologia , Dermatopatias Parasitárias/economia , Dermatopatias Parasitárias/parasitologia , Estados Unidos
5.
J Gynecol Oncol ; 30(3): e37, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30887758

RESUMO

OBJECTIVE: The purpose of this study was to assess the incidence rate of cervical intraepithelial neoplasia (CIN) and cervical cancer, and their costs according to age. METHODS: We collected data on annual incidence and medical costs of CIN and cervical cancer from 2010 until the end of 2014 from the Health Insurance Review and Assessment (HIRA) service. The CIN was classified into CIN3 (high-grade) requiring conization and CIN1/2 (low-grade) requiring observation. RESULTS: Incidence rates of CIN3 and cervical cancer are reducing over time, whereas CIN1/2 is increasing significantly (p for trend: <0.001). The peak ages of incidence were 25-29, 30-34, and 70-74 years old for CIN1/2, CIN3, and cervical cancer, respectively. The crude incidence of CIN1/2 increased by approximately 30% in 2014 compared to 5 years ago and demonstrated an increasing trend in all age groups. The CIN3 showed a significantly increasing trend in the age group of 30-39 years old, the cervical cancer was significantly reduced in all ages, except the 35-39 years old. The treatment for cervical cancer costs $3,342 per year, whereas the treatment for CIN3 and CIN1/2 cost $467 and $83, respectively. CONCLUSION: The crude incidence rate of cervical cancer is currently decreasing among Korean women, but the incidence rates and medical costs of CIN and cervical cancer are increasing in women in their 30s in Korea. These findings suggest that different strategies by age will be required for prevention of cervical cancer in Korea.


Assuntos
Neoplasia Intraepitelial Cervical/economia , Neoplasia Intraepitelial Cervical/epidemiologia , Custos de Cuidados de Saúde , Neoplasias do Colo do Útero/economia , Neoplasias do Colo do Útero/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia/economia , Biópsia/estatística & dados numéricos , Neoplasia Intraepitelial Cervical/terapia , Conização/economia , Conização/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Incidência , Pessoa de Meia-Idade , Gradação de Tumores , República da Coreia/epidemiologia , Neoplasias do Colo do Útero/terapia , Conduta Expectante/economia , Conduta Expectante/estatística & dados numéricos , Adulto Jovem
7.
J Surg Res ; 239: 125-135, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30825757

RESUMO

BACKGROUND: Surgical guidelines for soft tissue sarcoma (STS) emphasize pretreatment evaluation and reports of the perils of unplanned excision exist. Given the paucity of population-based data on this topic, our objective was to analyze clinical outcomes and costs of planned versus unplanned STS excisions in the Medicare population. METHODS: We analyzed 3913 surgical patients with STS ≥66 y old from 1992 to 2011 using the Surveillance, Epidemiology, and End Results-Medicare datafiles. Planned excisions were classified based on preoperative MRI and/or biopsy, whereas unplanned excisions were classified by excision as the first procedure. Inverse probability of treatment weighting with propensity scores was used to adjust for clinicopathologic differences. Re-excisions, complications, and Medicare payments were compared with multivariate models. Overall survival and disease-specific survival were analyzed using Cox proportional hazards and competing risk models. RESULTS: Before the first excision, 24.3% had an MRI and biopsy, 27.3% had an MRI, 11.4% had a biopsy, and 36.9% were unplanned. Re-excision rates were highest for unplanned excisions: 46.3% compared to 18.1%, 36.4%, and 29.7% for other groups (P < 0.0001). There was no difference in disease-specific survival or overall survival between groups (P > 0.05). Planned excisions were associated with increased Medicare costs (P < 0.05), with the first resection contributing to the majority of costs. Subgroup analyses by histologic grade and tumor size revealed similar results. CONCLUSIONS: Survival was comparable with greater health care costs in elderly patients undergoing planned STS excision. Although unplanned excisions remain a quality of care issue with high re-excision rates, these data have important implications for the surgical management of STS in the elderly.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Complicações Pós-Operatórias/economia , Cuidados Pré-Operatórios/economia , Reoperação/economia , Sarcoma/cirurgia , Idoso , Idoso de 80 Anos ou mais , Biópsia/economia , Biópsia/estatística & dados numéricos , Análise Custo-Benefício , Feminino , Humanos , Imagem por Ressonância Magnética/economia , Imagem por Ressonância Magnética/estatística & dados numéricos , Masculino , Margens de Excisão , Medicare/economia , Medicare/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Cuidados Pré-Operatórios/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Programa de SEER/estatística & dados numéricos , Sarcoma/diagnóstico por imagem , Sarcoma/mortalidade , Análise de Sobrevida , Resultado do Tratamento , Estados Unidos/epidemiologia
9.
Ann Diagn Pathol ; 39: 21-24, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30599380

RESUMO

BACKGROUND: There is contradictory evidence in literature with respect to diagnosis and management of follicular lesions of the thyroid gland. From surgical pathology stand point, pathologists require submission and processing of entire capsule for microscopic evaluation. This can be extremely challenging especially in larger lesions. METHOD: We studied the impact of submitting entire capsule on final pathologic diagnosis in cases on which only representative sections were submitted initially and entire capsule was submitted subsequently. RESULTS: A total of 80 specimens were identified. Mean size of the nodule in these cases was 4.4 ±â€¯1.9 cm. Mean initial tissue sections submitted were 11.6 ±â€¯3.6. Entire capsule was submitted subsequently in an additional 12.6 ±â€¯13.3 sections. Submission of entire capsule contributed to final diagnosis in 3 (3.8%) cases whereby foci of capsular microinvasion were identified. There was no significant difference in the requirement of subsequent sections in specimens grossed by residents compared to those grossed by pathologist assistants (10.4 ±â€¯10.8 vs. 14.4 ±â€¯14.9, p = 0.18). The processing cost of additional sections of capsule was $ 4143 in these cases. CONCLUSION: Processing of entire capsule in thyroid follicular lesions has a definitive yield that comes at a high cost. Thin slicing and looking for areas of gross abnormality such as mushrooming may be more practical especially in larger lesions.


Assuntos
Adenocarcinoma Folicular/diagnóstico , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/diagnóstico , Adenocarcinoma Folicular/patologia , Adenocarcinoma Folicular/cirurgia , Adulto , Biópsia/economia , Biópsia/métodos , Feminino , Humanos , Masculino , Estudos Retrospectivos , Sensibilidade e Especificidade , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
10.
Prostate Cancer Prostatic Dis ; 22(1): 101-109, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30127462

RESUMO

BACKGROUND: Low specificity of prostate-specific antigen results in a considerable number of unnecessary prostate biopsies in current practice. SelectMDx® predicts significant prostate cancer upon biopsy and is used to reduce the number of unnecessary initial prostate biopsies. Furthermore, potential overtreatment of insignificant prostate cancer can be reduced. Besides the diagnostic accuracy of the test, also the context in a specific country determines the potential health benefit and cost-effectiveness. Therefore, the health benefit and cost-effectiveness of SelectMDx were assessed in France, Germany, Italy, and Spain. SUBJECT AND METHODS: A decision model was used to compare the current standard of care in which men undergo initial prostate biopsy in case of an elevated prostate-specific antigen, to a strategy in which SelectMDx was used to select men for biopsy. Model inputs most relevant to each of the four countries were obtained. With use of the model long-term quality-adjusted life years (QALYs) and healthcare costs were calculated for both strategies. RESULTS: In all four countries, the SelectMDx resulted in QALY gain and cost savings compared with the current standard of care. In France, SelectMDx resulted in 0.022 QALYs gained and cost savings of €1217 per patient. For Germany, the model showed a QALY gain of 0.016 and a cost saving of €442. In Italy, the QALY gain and cost savings were 0.031 and €762. In Spain 0.020 QALYs were gained and €250 costs were saved. CONCLUSIONS: The results of the model showed that with SelectMDx, QALYs could be gained while saving healthcare costs in the initial diagnosis of prostate cancer. The significant presence of overtreatment in the current standard of care in all four countries was the main factor that resulted in the beneficial outcomes with SelectMDx.


Assuntos
Biópsia/economia , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/epidemiologia , Biomarcadores Tumorais , Biópsia/métodos , Tomada de Decisão Clínica , Análise Custo-Benefício , Árvores de Decisões , Europa (Continente)/epidemiologia , França , Alemanha , Humanos , Itália , Masculino , Modelos Estatísticos , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/terapia , Vigilância em Saúde Pública , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Sensibilidade e Especificidade , Espanha
11.
World J Urol ; 37(7): 1297-1303, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30276542

RESUMO

INTRODUCTION: Active surveillance (AS) seems to be a cost-effective strategy. However, most publications are based on simulation models of theoretical cohorts, and long-term implications are not usually considered. OBJECTIVE: To assess the real cost differences of two cohorts of men with low-risk prostate cancer (PCa) treated with AS or laparoscopic radical prostatectomy (LRP) in a public health system. MATERIALS AND METHODS: Patients diagnosed from 2005 to 2009 were included in an AS program (Group 1) or treated with LRP at diagnosis (Group 2), with a minimum follow-up of 5 years. Actual costs for each patient were calculated on an individual basis: Group 1: semiannual PSA measurements and repeat biopsies are scheduled every 1-3 years. Costs of outpatient clinic visits were calculated, as well as all tests required for monitoring or active treatment. Group 2: costs of the procedure, emergency visits, re-admissions and outpatient clinic visits were calculated, as well as costs of oncological salvage therapies or functional surgical procedures. RESULTS: Out of 151 men diagnosed with low-risk PC, 54 (35.8%) were included in an AS (Group 1) and 97 (64.2%) were submitted to LRP (Group 2). Mean follow-up for both groups was 6.5 years (SD 1.8) and 6.7 years (SD 1.4), respectively, p = 0.49. Group 1 had a total cost per patient of 2970.47€. Group 2 had a total cost per patient of 5694.06€. CONCLUSIONS: AS was associated with cost-saving over LRP. This cost reduction of AS in the management of low-risk PCa is based on the accounting of real costs of individual patients and confirms previously published estimation-based reports.


Assuntos
Custos de Cuidados de Saúde , Prostatectomia/economia , Neoplasias da Próstata/terapia , Conduta Expectante/economia , Idoso , Assistência Ambulatorial/economia , Biópsia/economia , Custos e Análise de Custo , Serviço Hospitalar de Emergência/economia , Hospitalização/economia , Humanos , Laparoscopia/economia , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/economia , Terapia de Salvação/economia , Espanha
12.
J Voice ; 33(4): 575-579, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29472150

RESUMO

OBJECTIVE: Given that financial considerations play an increasingly prominent role in clinical decision-making, we sought (1) to determine the cost-effectiveness of in-office biopsy for the patient, the provider, and the health-care system, and (2) to determine the diagnostic accuracy of in-office biopsy. STUDY DESIGN: Retrospective, financial analyses were performed. METHODS: Patients who underwent in-office (Current Procedural Terminology Code 31576) or operative biopsy (CPT Code 31535) for laryngopharyngeal lesions were included. Two financial analyses were performed: (1) the average cost of operating room (OR) versus in-office biopsy was calculated, and (2) a break-even analysis was calculated to determine the cost-effectiveness of in-office biopsy for the provider. In addition, the diagnostic accuracy of in-office biopsies and need for additional biopsies or procedures was recorded. RESULTS: Of the 48 patients included in the current study, 28 underwent in-office biopsy. A pathologic sample was obtained in 26 of 28 (92.9%) biopsies performed in the office. Of these patients, 16 avoided subsequent OR procedures. The average per patient cost was $7000 and $11,000 for in-office and OR biopsy, respectively. Break-even analysis demonstrated that the provider could achieve a profit 2 years after purchase of the necessary equipment. CONCLUSION: In-office laryngopharyngeal biopsies are accurate and, overall, more cost-effective than OR biopsies. Purchase of the channeled, distal chip laryngoscope and biopsy forceps to perform in-office biopsies can be profitable for a provider with a videolaryngoscopy tower. In-office biopsy should be considered the initial diagnostic tool for suspected laryngopharyngeal malignancies noted on videolaryngoscopy.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/economia , Biópsia/economia , Custos de Cuidados de Saúde , Doenças da Laringe/patologia , Laringoscopia/economia , Doenças Faríngeas/patologia , Análise Custo-Benefício , Humanos , Renda , Doenças da Laringe/economia , Doenças da Laringe/terapia , Visita a Consultório Médico/economia , Doenças Faríngeas/economia , Doenças Faríngeas/terapia , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos
13.
Cancer ; 125(6): 952-962, 2019 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-30561761

RESUMO

BACKGROUND: Active surveillance (AS) is a viable management option for approximately 50% of men who are newly diagnosed with prostate cancer. To the authors' knowledge, no direct comparisons between the different variants of AS protocols have been conducted to date. The authors developed a microsimulation decision model to evaluate which of 3 alternative AS protocols is optimal for men with low-risk prostate cancer, and compared each of these with immediate treatment. METHODS: Men who were diagnosed with low-risk prostate cancer at age 65 years were modeled as having been treated with either immediate therapy or via each of 3 AS protocols. Modeled AS protocols represent those in the literature; a modified AS protocol was included in a sensitivity analysis. Immediate therapy included radical prostatectomy, external-beam radiotherapy, or brachytherapy. Outcome measures were quality-adjusted life-years (QALYs) and costs. Cost-effectiveness analysis and deterministic and probabilistic sensitivity analyses were performed. RESULTS: Immediate therapy produced fewer QALYs than all variants of AS. Of the AS protocols evaluated, biennial biopsy was found to be the only efficient option, with an incremental cost-effectiveness ratio of $3490 per QALY compared with immediate therapy. It delayed the need for curative therapy by a mean of 56 months, and was found to be preferred in >86.9% of cases in probabilistic sensitivity analysis. A modified version of low-intensity AS dominated all other options. CONCLUSIONS: For a 65-year-old man with low-risk prostate cancer, AS with biennial biopsy appears to be highly cost-effective compared with common alternatives. An AS protocol using triennial biopsy was found to dominate all other strategies and should be considered for men who are comfortable with a longer period between biopsies. The optimal strategy depends on a patient's tolerance for periodic biopsies and comfort with delaying radical treatment. Physicians should incorporate these patient preferences into decision making.


Assuntos
Antígenos de Superfície/economia , Biópsia/economia , Exame Retal Digital/economia , Glutamato Carboxipeptidase II/economia , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/terapia , Conduta Expectante/economia , Idoso , Antígenos de Superfície/análise , Braquiterapia , Tomada de Decisão Clínica , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Glutamato Carboxipeptidase II/análise , Humanos , Masculino , Cadeias de Markov , Prostatectomia , Neoplasias da Próstata/metabolismo , Anos de Vida Ajustados por Qualidade de Vida
15.
Malar J ; 17(1): 425, 2018 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-30442132

RESUMO

BACKGROUND: A multi-country, community-based trial on scheduled screening and treatment for malaria in pregnancy was conducted in Benin, The Gambia and Burkina Faso. Despite standardized procedures and outcomes, the study became subject to rumours and accusations of placenta being sold for mystical and financial gain by trial staff, leading to drop-out rates of 30% and the consequent halting of placental biopsy sampling in Benin. This paper explores the role of socio-cultural beliefs related to placenta and identified additional factors contributing these rumours. METHODS: A qualitative comparative emergent-theory design was used to assess social factors related to trial implementation and uptake in the three countries. Data from participant observation, informal conversations, group discussions and interviews were triangulated and analysed with NVivo Qualitative Analysis software. RESULTS: Despite similar sociocultural beliefs about the sacred nature of the placenta in all three study countries, these beliefs did not affect participation rates in Burkina Faso and The Gambia and placenta-related rumours only emerged in Benin. Therefore, the presence of beliefs is not a sufficient condition to have generated placenta-selling fears. The rumours in Benin reflected the confluence of placenta-related beliefs and factors related to the implementation of the trial (including a catalysing adverse event and miscommunication during the informed consent procedure). Furthermore, distinct socio-political factors contributed to the emergence of rumours, including the historical distrust in governmental organizations and the tense relationship between some of the actors involved in the trial. CONCLUSION: Transdisciplinary social science research designs should accompany the implementation of the trial. The integration of multiple stakeholders' knowledge and involvement is required to define and solve upcoming barriers.


Assuntos
Biópsia/psicologia , Medo , Malária/psicologia , Placenta , Complicações Parasitárias na Gravidez/psicologia , Benin , Biópsia/economia , Feminino , Humanos , Consentimento Livre e Esclarecido , Malária/parasitologia , Gravidez , Complicações Parasitárias na Gravidez/parasitologia
16.
Lakartidningen ; 1152018 10 23.
Artigo em Sueco | MEDLINE | ID: mdl-30351440

RESUMO

Capio S:t Göran Prostate Cancer Center is located in Stockholm and offers testing for prostate cancer using a structured pathway including the blood-test Stockholm3 and MRI-targeted prostate biopsies. The diagnostic pathway is organized by dedicated nurses, offering information, testing, test results, as well as organizing further workup with MRI and biopsies for men with elevated risk. In this article, we describe initial experiences and introduces the Capio S:t Göran Model.


Assuntos
Procedimentos Clínicos , Programas de Rastreamento , Neoplasias da Próstata/diagnóstico , Idoso , Biópsia/economia , Biópsia/métodos , Biópsia/normas , Análise Custo-Benefício , Procedimentos Clínicos/economia , Procedimentos Clínicos/normas , Detecção Precoce de Câncer , Humanos , Imagem por Ressonância Magnética , Masculino , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Sobremedicalização/prevenção & controle , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/economia , Neoplasias da Próstata/patologia , Medição de Risco , Suécia , Fatores de Tempo
18.
Medicine (Baltimore) ; 97(36): e11962, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30200076

RESUMO

Prostate-specific antigen is not useful for detection of prostate cancer in Chinese men. The major problems in prostate cancer patients are overdiagnosis and overtreatment. The objective of the study was to test the hypothesis that targeted biopsy is an accurate diagnostic tool for prostate cancer detection than standard biopsy in Chinese men.Total, 998 patients whom multiparticulate multiparametric magnetic resonance imaging had revealed at least 1 lesion in the prostate were included in a cohort. Patients were subjected to magnetic resonance imaging (MRI)/ultrasound (US) fusion-guided biopsy followed US-guided biopsy. Benefits of a diagnostic test were evaluated by decision curve analysis. Patients who were diagnosed as having prostate cancer by either of biopsies were subjected to radical prostatectomies followed by whole-mounted pathology (n = 578). Spearman rank correlation was performed between the biopsy results and the subtype of prostate cancer at 99% of confidence level.With respect to whole-mounted pathology, for US-guided biopsy, MRI/US fusion-guided biopsy, and combined data of both biopsies, sensitivities were 0.973, 0.983, and 0.973 and accuracies were 0.837, 0.91, and 0.917, respectively. MRI/US fusion-guided biopsy (P = .165) and combined data of both biopsies (P = .182) had the same specificity to whole-mount pathology. However, a US-guided biopsy had not the same specificity to whole-mount pathology (P = .0003). Decision-making zones for radical prostatectomy of different biopsies were in the order of combined data of both biopsies >MRI/US fusion-guided biopsy >US-guided biopsy.Only the targeted biopsy is recommended for the diagnosis of prostate cancer.


Assuntos
Biópsia/métodos , Imagem por Ressonância Magnética Intervencionista , Neoplasias da Próstata/diagnóstico , Ultrassonografia de Intervenção , Biópsia/economia , China , Humanos , Imagem por Ressonância Magnética Intervencionista/economia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Próstata/diagnóstico por imagem , Próstata/patologia , Próstata/cirurgia , Prostatectomia , Neoplasias da Próstata/economia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Sensibilidade e Especificidade , Ultrassonografia de Intervenção/economia
19.
Urology ; 122: 158-161, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30195010

RESUMO

OBJECTIVE: To assess national and regional practice patterns and rates of pathologic specimen identification sent at time of pyeloplasty, as well as project associated costs, we used a national administrative database. The rate at which the excised ureteropelvic junction obstruction (UPJO) is sent for pathologic identification is variable, arguably without a clear clinical purpose. MATERIALS / METHODS: Utilizing a national administrative database of privately insured patients, 1496 individual cases were identified using international classification of diseases (ICD) and Current Procedural Terminology (CPT) coding. Patients from 0-18 years of age were included whose pyeloplasty was performed during 2010-2014. Patients who were and were not billed for pathologic identification at time of surgery were identified. Regional practice patterns and associated costs were determined. RESULTS: One thousand four hundred and ninety-six pyeloplasty cases were identified (68.2% males). Specimens were sent for pathologic identification in 827 cases (55%). Average age was 5.8 years for those without pathology and 4.6 years for those in whom a specimen was billed. Regionally, the Western United States was least likely to bill for surgical pathology (49%). The parental out-of-pocket payment for the encounter was on average $1518 for cases in which pathology was sent and $1398 for those cases for which no pathology bill was identified. CONCLUSION: Pediatric pyeloplasty is a common surgical procedure for which a pathologic specimen is sent in as many as 55% of cases in this cohort. Regional differences exist across the country and there is an associated slightly higher out-of-pocket cost in cases for which pathologic specimens are sent at time of pyeloplasty.


Assuntos
Padrões de Prática Médica/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Obstrução Ureteral/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Adolescente , Biópsia/economia , Biópsia/métodos , Biópsia/estatística & dados numéricos , Criança , Pré-Escolar , Estudos de Coortes , Bases de Dados Factuais , Feminino , Gastos em Saúde/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Pelve Renal/patologia , Pelve Renal/cirurgia , Masculino , Procedimentos Cirúrgicos Reconstrutivos/economia , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Estados Unidos , Ureter/patologia , Ureter/cirurgia , Obstrução Ureteral/economia , Obstrução Ureteral/patologia , Procedimentos Cirúrgicos Urológicos/economia , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos
20.
JAMA Dermatol ; 154(9): 1025-1031, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-29998292

RESUMO

Importance: A recently described noninvasive gene expression test (the pigmented lesion assay [PLA]) with adhesive patch-based sampling has the potential to rule out melanoma and the need for surgical biopsy of pigmented lesions suggestive of melanoma with a negative predictive value of 99% compared with 83% for the histopathologic standard of care. The cost implications of using this molecular test vs visual assessment followed by biopsy and histopathologic assessment (VAH) have not been evaluated. Objective: To determine potential cost savings of PLA use vs the VAH pathway. Design, Setting, and Participants: This health economic analysis performed from a US payer perspective was based on consensus treatment guidelines and fee schedules from the Centers for Medicare & Medicaid Services. Data for model input were derived from routine use of the test in US dermatology practices and literature. Participants included patients with primary cutaneous pigmented lesions suggestive of melanoma. Data were analyzed from February 8 to December 1, 2017. Main Outcomes and Measures: The primary analysis consisted of the relative reduction in costs of diagnostic surgical procedures for PLA vs VAH management. Additional analyses included stage-related treatment costs associated with delays in diagnosis. Results: In the cost analysis for this economic model, the relative reduction in surgical procedure costs (biopsy and subsequent excision), assuming $0 for the PLA to facilitate multiple comparison scenarios, was -$395 compared with VAH. The relative reduction in stage-related treatment costs associated with the PLA was -$433 compared with VAH, primarily associated with avoidance of delays due to false-negative diagnoses. Surveillance costs were reduced by -$119 with the PLA. The total cost of fully adjudicating a lesion suggestive of melanoma by VAH was $947. At a mean selling price reference point for PLA of $500, cost savings of $447 (47%) per lesion tested could be realized. Conclusions and Relevance: The results of this analysis suggest that the PLA reduces cost and may improve the care of patients with primary pigmented skin lesions suggestive of melanoma.


Assuntos
Testes Genéticos/economia , Melanoma/diagnóstico , Melanoma/patologia , Técnicas de Diagnóstico Molecular/economia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Biópsia/economia , Redução de Custos , Diagnóstico Tardio/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Modelos Econômicos , Pele/patologia
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