Document Detail


Cost-effectiveness of computed tomography and ultrasound in the diagnosis of appendicitis.
MedLine Citation:
PMID:  18645669     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Diagnosis of acute appendicitis is difficult in nearly 30% of patients with pain in low right quadrant. Diagnostic imaging may provide a means of a more accurate diagnosis. OBJECTIVE: The cost-effectiveness of diagnostic image tests was calculated for comparison with routine physical examination in patients with abdominal pain suspected to be appendicitis. MATERIALS AND METHODS: A cost-effectiveness protocol was designed, using a decision analysis model. The standard case was a patient with abdominal pain in right lower quadrant and suspicion of appendicitis. Three independent diagnostic alternatives were selected--ultrasonography, abdominal tomography and physical exam in hospital with the subject under observation less than six hours. Operative characteristics, study design and costs of interventions and outcomes were assessed. The main outcome consisted of a confirmed diagnosis of appendicitis. The point of view taken was that of health maintenance organizations. Direct and indirect medical costs were measured. Time horizon used was three months. A one way sensitivity analysis was made. RESULTS: For a prepaid system, the most cost-effective strategy was abdominal tomography, with a cost-effectiveness ratio of US$965/diagnosed patient. For public system, the most cost-effective strategy was abdominal tomography, with a cost-effectiveness ratio of US$492/diagnosed patient. CONCLUSIONS: Imaging diagnostic methods, in cases of abdominal pain suspected to be appendicitis, are more cost-effective than physical exam to make accurate diagnostic decisions. Tomography offers the best cost-effectiveness in prepaid system and in public health system.
Authors:
Javier Romero; Alvaro Sanabria; Miguel Angarita; Juan Carlos Varón
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Biomédica : revista del Instituto Nacional de Salud     Volume:  28     ISSN:  0120-4157     ISO Abbreviation:  Biomedica     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-07-22     Completed Date:  2008-11-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8205605     Medline TA:  Biomedica     Country:  Colombia    
Other Details:
Languages:  eng     Pagination:  139-47     Citation Subset:  IM    
Affiliation:
Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, D.C, Colombia.
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MeSH Terms
Descriptor/Qualifier:
Abdominal Pain / diagnosis,  economics,  radiography,  ultrasonography
Appendicitis / diagnosis*,  economics*,  radiography,  ultrasonography
Cost-Benefit Analysis / economics*
Decision Support Techniques
Health Care Costs
Humans
Models, Economic
Tomography, X-Ray Computed / economics*
Treatment Outcome
Ultrasonography / economics*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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