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Health-economic evaluation of three imaging strategies in patients with suspected colorectal liver metastases: Gd-EOB-DTPA-enhanced MRI vs. extracellular contrast media-enhanced MRI and 3-phase MDCT in Germany, Italy and Sweden.

https://arctichealth.org/en/permalink/ahliterature150664
Source
Eur Radiol. 2009 Jun;19 Suppl 3:S753-63
Publication Type
Article
Date
Jun-2009
Author
C J Zech
L. Grazioli
E. Jonas
M. Ekman
R. Niebecker
S. Gschwend
J. Breuer
L. Jönsson
S. Kienbaum
Author Affiliation
Institute of Clinical Radiology, University Hospital Munich-Grosshadern, Munich, Germany. Christoph.Zech@med.uni-muenchen.de
Source
Eur Radiol. 2009 Jun;19 Suppl 3:S753-63
Date
Jun-2009
Language
English
Publication Type
Article
Keywords
Colorectal Neoplasms - diagnosis - economics - epidemiology
Contrast Media - economics
Gadolinium DTPA - diagnostic use - economics
Germany - epidemiology
Health Care Costs - statistics & numerical data
Humans
Italy - epidemiology
Liver Neoplasms - diagnosis - economics - epidemiology - secondary
Magnetic Resonance Imaging - economics - statistics & numerical data
Sweden - epidemiology
Tomography, X-Ray Computed - statistics & numerical data
Abstract
The purpose of this study was to perform an economic evaluation of hepatocyte-specific Gd-EOB-DTPA enhanced MRI (PV-MRI) compared to extracellular contrast-media-enhanced MRI (ECCM-MRI) and three-phase-MDCT as initial modalities in the work-up of patients with metachronous colorectal liver metastases. The economic evaluation was performed with a decision-tree model designed to estimate all aggregated costs depending on the initial investigation. Probabilities on the need for further imaging to come to a treatment decision were collected through interviews with 13 pairs of each a radiologist and a liver surgeon in Germany, Italy and Sweden. The rate of further imaging needed was 8.6% after initial PV-MRI, 18.5% after ECCM-MRI and 23.5% after MDCT. Considering the cost of all diagnostic work-up, intra-operative treatment changes and unnecessary surgery, a strategy starting with PV-MRI with 959 Euro was cost-saving compared to ECCM-MRI (1,123 Euro) and MDCT (1,044 Euro) in Sweden. In Italy and Germany, PV-MRI was cost-saving compared to ECCM-MRI and had total costs similar to MDCT. In conclusion, our results indicate that PV-MRI can lead to cost savings by improving pre-operative planning and decreasing intra-operative changes. The higher cost of imaging with PV-MRI is offset in such a scenario by lower costs for additional imaging and less intra-operative changes.
PubMed ID
19484243 View in PubMed
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Nationwide cohort study of post-gastric bypass hypoglycaemia including 5,040 patients undergoing surgery for obesity in 1986-2006 in Sweden.

https://arctichealth.org/en/permalink/ahliterature96868
Source
Diabetologia. 2010 May 22;
Publication Type
Article
Date
May-22-2010
Author
R. Marsk
E. Jonas
F. Rasmussen
E. Näslund
Author Affiliation
Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, SE-182 88, Stockholm, Sweden.
Source
Diabetologia. 2010 May 22;
Date
May-22-2010
Language
English
Publication Type
Article
Abstract
AIMS/HYPOTHESIS: Symptomatic hypoglycaemia with related confusion, syncope, epilepsy or seizures is a newly recognised complication of gastric bypass surgery for obesity. The incidence of these conditions is not known. We therefore studied the incidence of post-gastric bypass hypoglycaemia and related symptoms in patients who have undergone gastric bypass and a reference cohort from the general population of Sweden. METHODS: This is a nationwide cohort study based on national registries with 5,040 persons who underwent gastric bypass, vertical banded gastroplasty or gastric banding for obesity in Sweden between 1 January 1986 and 31 December 2006 and a cohort of ten referents per patient matched for sex and age randomly sampled from the general population. The incidence rates of hospitalisation for hypoglycaemia, confusion, syncope, epilepsy or seizures before and after dates of surgery or inclusion in the reference cohort were studied. RESULTS: Preoperative incidences of hospitalisation for hypoglycaemia were similar in the surgical and referent cohorts. After gastric bypass surgery, the adjusted hazard ratios were significantly elevated for hypoglycaemia (2.7 [95% CI 1.2-6.3]), confusion (2.8 [1.3-6.0]), syncope (4.9 [3.4-7.0]), epilepsy (3.0 [2.1-4.3]) and seizures (7.3 [5.0-10.8]). The proportions of gastric bypass patients and reference participants affected by hypoglycaemia were very low (0.2% and 0.04%, respectively). There was no increased risk of hypoglycaemia after vertical banded gastroplasty or gastric banding compared with the referent population. CONCLUSIONS/INTERPRETATION: Obese persons who have undergone gastric bypass have an increased risk of hospitalisation for diagnoses associated with post-gastric bypass hypoglycaemia, although few patients are affected.
PubMed ID
20495972 View in PubMed
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