| Evaluating the cost-effectiveness of anterior uveitis investigation by Canadian ophthalmologists. | |
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MedLine Citation:
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PMID: 19020630 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: To evaluate the cost-effectiveness of anterior uveitis investigation by Canadian ophthalmologists and to assess the role of implementing national clinical guidelines for such investigation. METHODS: Based on data extracted from the Canadian National Uveitis Survey (CNUS, 2007 version), the cost of investigating a patient with anterior uveitis, according to current practice patterns of Canadian ophthalmologists, was determined and grouped across 4 clinical scenarios: (i) nongranulomatous anterior uveitis in an adult, (ii) granulomatous anterior uveitis in an adult, (iii) granulomatous anterior uveitis with suspected sarcoidosis in an adult or a child, and (iv) nongranulomatous anterior uveitis in a child. Similarly, the cost of investigating a patient with anterior uveitis as per published evidence-based guidelines was determined and compared with the current practice pattern using a cost-minimization model, sensitivity analyses, and Monte Carlo simulations. RESULTS: Ophthalmologists were found to consistently order more tests than recommended by evidence-based guidelines, across each of the scenarios studied (p < 0.05). Overall, complete blood count, erythrocyte sedimentation rate, C-reactive protein, antinuclear antibody, and rheumatoid factor were the most commonly ordered extraneous tests that were not included in the evidence-based guidelines for the routine investigation of anterior uveitis. Also, there were significant differences in the cost of investigating a patient with anterior uveitis when compared with those predicted by adhering to evidence-based clinical practice guidelines. Cost minimization and sensitivity analyses revealed that published guidelines imparted cost savings when compared with current practice patterns across the 4 clinical scenarios studied (p < 0.01). The maximum additional cost was associated with investigating nongranulomatous anterior uveitis in an adult, where a minimal additional cost of $75 per patient was spent. For granulomatous anterior uveitis in an adult, the additional cost was approximately $40, whereas the additional cost for investigating an adult or a child with suspected sarcoidosis was $36. Only $11 of additional cost was spent in the workup of a child with nongranulomatous anterior uveitis. When applied to the Canadian population, adherence to the Clinical Practice Guidelines recommended by the CNUS may result in cost savings of $600,000 per year to the Canadian health care system.Interpretation: Adherence to the evidence-based Clinical Practice Guidelines recommended by the CNUS may result in significant cost savings, with virtually no loss of sensitivity in the routine investigation of anterior uveitis in Canada. |
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Authors:
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Jason Noble; Hussein Hollands; Farzin Forooghian; Arash Yazdani; Sanjay Sharma; David T Wong; Larissa Derzko-Dzulynsky |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Canadian journal of ophthalmology. Journal canadien d'ophtalmologie Volume: 43 ISSN: 0008-4182 ISO Abbreviation: Can. J. Ophthalmol. Publication Date: 2008 Dec |
Date Detail:
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Created Date: 2008-11-21 Completed Date: 2009-02-12 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0045312 Medline TA: Can J Ophthalmol Country: Canada |
Other Details:
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Languages: eng Pagination: 652-7 Citation Subset: IM |
Affiliation:
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Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Canada Child Cost Savings Cost-Benefit Analysis Diagnostic Techniques, Ophthalmological / economics* Guideline Adherence / economics Health Care Costs Humans Models, Economic Monte Carlo Method Ophthalmology / economics* Physician's Practice Patterns / economics Practice Guidelines as Topic Uveitis, Anterior / diagnosis*, economics*, etiology |
| Comments/Corrections | |
Comment In:
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Can J Ophthalmol. 2008 Dec;43(6):630-3
[PMID:
19020626
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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