CT or EUS for the initial staging of esophageal cancer? A cost minimization analysis
Background: Patients with advanced (T4 and/or M1) esophageal cancer are offered palliative therapy. Computed tomography (CT) is sensitive for distant metastases but is less sensitive than endosonography for T4 disease and celiac lymphadenopathy. The aim of this study was to determine whether initial...
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| Veröffentlicht in: | Gastrointestinal endoscopy 2000-12, Vol.52 (6), p.715-720 |
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| creator | Hadzijahic, Neven Wallace, Michael B. Hawes, Robert H. VanVelse, Annette LeVeen, Margaret Marsi, Vicki Hoffman, Brenda J. Sahai, Anand V. |
| description | Background: Patients with advanced (T4 and/or M1) esophageal cancer are offered palliative therapy. Computed tomography (CT) is sensitive for distant metastases but is less sensitive than endosonography for T4 disease and celiac lymphadenopathy. The aim of this study was to determine whether initial CT or endosonography costs less to diagnose advanced esophageal cancer.
Methods: A decision model compared the costs of the 2 strategies. Sensitivity analysis and threshold analysis were used to identify the most important determinants of the overall cost of identifying advanced disease.
Results: Initial CT is the least costly strategy if the probability of finding advanced disease by initial CT is greater than 20%, if the probability of finding advanced disease by initial endoscopic ultrasound (EUS) is less than 30%, or if the cost of EUS is greater than 3.5 times the cost of CT. However, in our referral center population, endosonography found advanced disease more frequently than CT (44% vs. 13%;
p < 0.0001) and the least costly strategy was initial endosonography (expected cost $804 vs. $844).
Conclusion: CT remains as the initial staging test of choice in most clinical settings. However, in referral centers, initial EUS may be reasonable, but individualized model inputs must be obtained before reliable conclusions can be drawn. (Gastrointest Endosc 2000;52:715-20.) |
| doi_str_mv | 10.1067/mge.2000.108481 |
| format | Article |
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Methods: A decision model compared the costs of the 2 strategies. Sensitivity analysis and threshold analysis were used to identify the most important determinants of the overall cost of identifying advanced disease.
Results: Initial CT is the least costly strategy if the probability of finding advanced disease by initial CT is greater than 20%, if the probability of finding advanced disease by initial endoscopic ultrasound (EUS) is less than 30%, or if the cost of EUS is greater than 3.5 times the cost of CT. However, in our referral center population, endosonography found advanced disease more frequently than CT (44% vs. 13%;
p < 0.0001) and the least costly strategy was initial endosonography (expected cost $804 vs. $844).
Conclusion: CT remains as the initial staging test of choice in most clinical settings. However, in referral centers, initial EUS may be reasonable, but individualized model inputs must be obtained before reliable conclusions can be drawn. (Gastrointest Endosc 2000;52:715-20.)</description><identifier>ISSN: 0016-5107</identifier><identifier>EISSN: 1097-6779</identifier><identifier>DOI: 10.1067/mge.2000.108481</identifier><identifier>PMID: 11115901</identifier><identifier>CODEN: GAENBQ</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Adult ; Aged ; Analysis of Variance ; Biological and medical sciences ; Cost-Benefit Analysis ; Decision Support Techniques ; Endosonography - economics ; Endosonography - methods ; Esophageal Neoplasms - diagnostic imaging ; Esophageal Neoplasms - pathology ; Esophagus ; Female ; Gastroenterology. Liver. Pancreas. Abdomen ; Hospital Costs ; Humans ; Male ; Medical sciences ; Middle Aged ; Multivariate Analysis ; Neoplasm Staging - economics ; Neoplasm Staging - methods ; Probability ; Sensitivity and Specificity ; Tomography, X-Ray Computed - economics ; Tomography, X-Ray Computed - methods ; Tumors ; United States</subject><ispartof>Gastrointestinal endoscopy, 2000-12, Vol.52 (6), p.715-720</ispartof><rights>2000 American Society for Gastrointestinal Endoscopy</rights><rights>2001 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c371t-42916714fac86903d28b4fc4b14bb0ba128876365884c27eb18a22e1fad3455a3</citedby><cites>FETCH-LOGICAL-c371t-42916714fac86903d28b4fc4b14bb0ba128876365884c27eb18a22e1fad3455a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1067/mge.2000.108481$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,778,782,3539,27911,27912,45982</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=835961$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11115901$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hadzijahic, Neven</creatorcontrib><creatorcontrib>Wallace, Michael B.</creatorcontrib><creatorcontrib>Hawes, Robert H.</creatorcontrib><creatorcontrib>VanVelse, Annette</creatorcontrib><creatorcontrib>LeVeen, Margaret</creatorcontrib><creatorcontrib>Marsi, Vicki</creatorcontrib><creatorcontrib>Hoffman, Brenda J.</creatorcontrib><creatorcontrib>Sahai, Anand V.</creatorcontrib><title>CT or EUS for the initial staging of esophageal cancer? A cost minimization analysis</title><title>Gastrointestinal endoscopy</title><addtitle>Gastrointest Endosc</addtitle><description>Background: Patients with advanced (T4 and/or M1) esophageal cancer are offered palliative therapy. Computed tomography (CT) is sensitive for distant metastases but is less sensitive than endosonography for T4 disease and celiac lymphadenopathy. The aim of this study was to determine whether initial CT or endosonography costs less to diagnose advanced esophageal cancer.
Methods: A decision model compared the costs of the 2 strategies. Sensitivity analysis and threshold analysis were used to identify the most important determinants of the overall cost of identifying advanced disease.
Results: Initial CT is the least costly strategy if the probability of finding advanced disease by initial CT is greater than 20%, if the probability of finding advanced disease by initial endoscopic ultrasound (EUS) is less than 30%, or if the cost of EUS is greater than 3.5 times the cost of CT. However, in our referral center population, endosonography found advanced disease more frequently than CT (44% vs. 13%;
p < 0.0001) and the least costly strategy was initial endosonography (expected cost $804 vs. $844).
Conclusion: CT remains as the initial staging test of choice in most clinical settings. However, in referral centers, initial EUS may be reasonable, but individualized model inputs must be obtained before reliable conclusions can be drawn. (Gastrointest Endosc 2000;52:715-20.)</description><subject>Adult</subject><subject>Aged</subject><subject>Analysis of Variance</subject><subject>Biological and medical sciences</subject><subject>Cost-Benefit Analysis</subject><subject>Decision Support Techniques</subject><subject>Endosonography - economics</subject><subject>Endosonography - methods</subject><subject>Esophageal Neoplasms - diagnostic imaging</subject><subject>Esophageal Neoplasms - pathology</subject><subject>Esophagus</subject><subject>Female</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Hospital Costs</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Neoplasm Staging - economics</subject><subject>Neoplasm Staging - methods</subject><subject>Probability</subject><subject>Sensitivity and Specificity</subject><subject>Tomography, X-Ray Computed - economics</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>Tumors</subject><subject>United States</subject><issn>0016-5107</issn><issn>1097-6779</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10EFLHDEUwPEgSl1tz95KQOhtNC-TmWRORRarguCh6zm8ybxZU2Ym22RW0E9vll3ak7k8En4J4c_YBYgrELW-Htd0JYXY7YwycMQWIBpd1Fo3x2whBNRFBUKfsrOU_mRnZAlf2CnkVTUCFmy1XPEQ-e3zb97nOb8Q95OfPQ48zbj205qHnlMKmxdcUz51ODmKP_kNdyHNfMx69O84-zBxnHB4Sz59ZSc9Dom-HeY5e_51u1reF49Pdw_Lm8fClRrmQskGag2qR2fqRpSdNK3qnWpBta1oEaQxui7ryhjlpKYWDEpJ0GNXqqrC8pz92L-7ieHvltJsR58cDQNOFLbJaqmMKKHK8HoPXQwpRertJvoR45sFYXchbQ5pdyHtPmS-8f3w9LYdqfvvD-UyuDwATA6HPuYuPv1zpqyaeqeavaKc4dVTtMl5ygU7H8nNtgv-0y98ANUFjJM</recordid><startdate>20001201</startdate><enddate>20001201</enddate><creator>Hadzijahic, Neven</creator><creator>Wallace, Michael B.</creator><creator>Hawes, Robert H.</creator><creator>VanVelse, Annette</creator><creator>LeVeen, Margaret</creator><creator>Marsi, Vicki</creator><creator>Hoffman, Brenda J.</creator><creator>Sahai, Anand V.</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20001201</creationdate><title>CT or EUS for the initial staging of esophageal cancer? A cost minimization analysis</title><author>Hadzijahic, Neven ; Wallace, Michael B. ; Hawes, Robert H. ; VanVelse, Annette ; LeVeen, Margaret ; Marsi, Vicki ; Hoffman, Brenda J. ; Sahai, Anand V.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c371t-42916714fac86903d28b4fc4b14bb0ba128876365884c27eb18a22e1fad3455a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2000</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Analysis of Variance</topic><topic>Biological and medical sciences</topic><topic>Cost-Benefit Analysis</topic><topic>Decision Support Techniques</topic><topic>Endosonography - economics</topic><topic>Endosonography - methods</topic><topic>Esophageal Neoplasms - diagnostic imaging</topic><topic>Esophageal Neoplasms - pathology</topic><topic>Esophagus</topic><topic>Female</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Hospital Costs</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Neoplasm Staging - economics</topic><topic>Neoplasm Staging - methods</topic><topic>Probability</topic><topic>Sensitivity and Specificity</topic><topic>Tomography, X-Ray Computed - economics</topic><topic>Tomography, X-Ray Computed - methods</topic><topic>Tumors</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hadzijahic, Neven</creatorcontrib><creatorcontrib>Wallace, Michael B.</creatorcontrib><creatorcontrib>Hawes, Robert H.</creatorcontrib><creatorcontrib>VanVelse, Annette</creatorcontrib><creatorcontrib>LeVeen, Margaret</creatorcontrib><creatorcontrib>Marsi, Vicki</creatorcontrib><creatorcontrib>Hoffman, Brenda J.</creatorcontrib><creatorcontrib>Sahai, Anand V.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Gastrointestinal endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hadzijahic, Neven</au><au>Wallace, Michael B.</au><au>Hawes, Robert H.</au><au>VanVelse, Annette</au><au>LeVeen, Margaret</au><au>Marsi, Vicki</au><au>Hoffman, Brenda J.</au><au>Sahai, Anand V.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>CT or EUS for the initial staging of esophageal cancer? A cost minimization analysis</atitle><jtitle>Gastrointestinal endoscopy</jtitle><addtitle>Gastrointest Endosc</addtitle><date>2000-12-01</date><risdate>2000</risdate><volume>52</volume><issue>6</issue><spage>715</spage><epage>720</epage><pages>715-720</pages><issn>0016-5107</issn><eissn>1097-6779</eissn><coden>GAENBQ</coden><abstract>Background: Patients with advanced (T4 and/or M1) esophageal cancer are offered palliative therapy. Computed tomography (CT) is sensitive for distant metastases but is less sensitive than endosonography for T4 disease and celiac lymphadenopathy. The aim of this study was to determine whether initial CT or endosonography costs less to diagnose advanced esophageal cancer.
Methods: A decision model compared the costs of the 2 strategies. Sensitivity analysis and threshold analysis were used to identify the most important determinants of the overall cost of identifying advanced disease.
Results: Initial CT is the least costly strategy if the probability of finding advanced disease by initial CT is greater than 20%, if the probability of finding advanced disease by initial endoscopic ultrasound (EUS) is less than 30%, or if the cost of EUS is greater than 3.5 times the cost of CT. However, in our referral center population, endosonography found advanced disease more frequently than CT (44% vs. 13%;
p < 0.0001) and the least costly strategy was initial endosonography (expected cost $804 vs. $844).
Conclusion: CT remains as the initial staging test of choice in most clinical settings. However, in referral centers, initial EUS may be reasonable, but individualized model inputs must be obtained before reliable conclusions can be drawn. (Gastrointest Endosc 2000;52:715-20.)</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>11115901</pmid><doi>10.1067/mge.2000.108481</doi><tpages>6</tpages></addata></record> |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Adult Aged Analysis of Variance Biological and medical sciences Cost-Benefit Analysis Decision Support Techniques Endosonography - economics Endosonography - methods Esophageal Neoplasms - diagnostic imaging Esophageal Neoplasms - pathology Esophagus Female Gastroenterology. Liver. Pancreas. Abdomen Hospital Costs Humans Male Medical sciences Middle Aged Multivariate Analysis Neoplasm Staging - economics Neoplasm Staging - methods Probability Sensitivity and Specificity Tomography, X-Ray Computed - economics Tomography, X-Ray Computed - methods Tumors United States |
| title | CT or EUS for the initial staging of esophageal cancer? A cost minimization analysis |
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