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24 records – page 1 of 3.

[Back pain, MRI scanning and MTV investigation].

https://arctichealth.org/en/permalink/ahliterature178274
Source
Ugeskr Laeger. 2004 Sep 6;166(37):3215-6
Publication Type
Article
Date
Sep-6-2004

[Clinical and economical effectiveness of the treatment of focal epilepsies].

https://arctichealth.org/en/permalink/ahliterature159576
Source
Zh Nevrol Psikhiatr Im S S Korsakova. 2008;Suppl 2:57-62
Publication Type
Article
Date
2008
Author
S V Kotov
Iu A Belova
I G Rudakova
A S Kotov
Source
Zh Nevrol Psikhiatr Im S S Korsakova. 2008;Suppl 2:57-62
Date
2008
Language
Russian
Publication Type
Article
Keywords
Adult
Anticonvulsants - economics - therapeutic use
Cost-Benefit Analysis
Electroencephalography - economics
Epilepsies, Partial - diagnosis - economics - therapy
Female
Follow-Up Studies
Health Care Costs - trends
Humans
Magnetic Resonance Imaging - economics
Male
Russia
Tomography, X-Ray Computed - economics
Abstract
One hundred and seventy-three patients with symptomatic and probable symptomatic epilepsies, mean age 31.2 years, were studied. The study included evaluation of anamnesis, clinical and neurological examination, routine EEG and/or video-EEG-monitoring, X-ray CT and/or MRI of the brain. The antiepileptic therapy was corrected. The duration of follow-up study was 2 years. General neurologist therapy (initial therapy) and epileptologist therapy (final therapy) were compared using cost-effectiveness analysis, frequency of using different drugs, ABC- and VEN-analysis. The final therapy was effective in 93.1% of cases, a remission was achieved in 53.2%. The ineffective therapy decreased from 56.6 to 6.9%. The ineffective expenses for the initial therapy were 82.8%. The final therapy was significantly effective (p = 0.001) and expensive (p = 0.004) but the cost difference was low (3420 roubles/year).
PubMed ID
19431252 View in PubMed
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Cost comparison of auditory brainstem response versus magnetic resonance imaging screening of acoustic neuroma.

https://arctichealth.org/en/permalink/ahliterature181502
Source
J Otolaryngol. 2003 Dec;32(6):394-9
Publication Type
Article
Date
Dec-2003
Author
Gordon Cheng
Robert Smith
Andre K W Tan
Author Affiliation
Deparment of Diagnostic Radiology, Queen's University, Kingston, Ontario.
Source
J Otolaryngol. 2003 Dec;32(6):394-9
Date
Dec-2003
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Audiometry, Evoked Response - economics - methods
Cost-Benefit Analysis
Evoked Potentials, Auditory, Brain Stem
Female
Hearing Loss, Sensorineural - diagnosis - etiology
Humans
Magnetic Resonance Imaging - economics - methods
Male
Mass Screening - economics - methods
Middle Aged
Neuroma, Acoustic - complications - diagnosis - economics
Ontario
Tomography, X-Ray Computed - economics
Abstract
The cost-effectiveness of current diagnostic approaches employed in patients with suspected acoustic neuroma was evaluated. Currently, patients with signs and symptoms suggestive of acoustic neuroma, such as sudden unilateral hearing loss and/or tinnitus, undergo auditory brainstem response (ABR) screening tests to rule out this condition. If the ABR is normal, acoustic neuroma can be ruled out. However, if the ABR is abnormal, magnetic resonance imaging (MRI) or computed tomography is necessary to confirm the diagnosis. When one considers the total costs of this screening approach, one can ask whether straight MRI screening of all of these patients would be a more cost-effective approach to diagnosing this condition. A retrospective chart review of patient records obtained from the acoustic diagnostics laboratory at Hotel Dieu Hospital, Kingston, Ontario, was performed. A database of patients who have undergone ABR testing over the past 2 years was compiled and analyzed to assess how many of them went on to receive MRI. The total costs (based on Ontario Health Insurance Plan [OHIP] fee schedule rates) of this approach were compared with the estimated costs of straight MRI screening performed on the same patient population. By making such an analysis, decisions regarding the most cost-effective approach to screening for acoustic neuroma can be objectively assessed.
PubMed ID
14967086 View in PubMed
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Cost-effectiveness of intravenous thrombolysis with alteplase within a 3-hour window after acute ischemic stroke.

https://arctichealth.org/en/permalink/ahliterature166388
Source
Stroke. 2007 Jan;38(1):85-9
Publication Type
Article
Date
Jan-2007
Author
Lars Ehlers
Grethe Andersen
Lone Beltoft Clausen
Merete Bech
Mette Kjølby
Author Affiliation
HTA Unit, Aarhus University Hospital, Olof Palmes Allé 17, 8200 Aarhus N, Denmark. le@ag.aaa.dk
Source
Stroke. 2007 Jan;38(1):85-9
Date
Jan-2007
Language
English
Publication Type
Article
Keywords
Acute Disease
Brain Ischemia - diagnosis - drug therapy
Clinical Protocols - standards
Cost-Benefit Analysis
Decision Trees
Denmark
Fibrinolytic Agents - economics - therapeutic use
Health Care Costs
Humans
Infusions, Intravenous
Magnetic Resonance Imaging - economics - utilization
Markov Chains
Models, Econometric
Monte Carlo Method
Patient Selection
Predictive value of tests
Preoperative Care - standards
Quality-Adjusted Life Years
Stroke - diagnosis - drug therapy
Thrombolytic Therapy - economics
Time
Time Factors
Tissue Plasminogen Activator - administration & dosage - economics - therapeutic use
Treatment Outcome
Abstract
The aim of this study was to assess the costs and cost-effectiveness of intravenous thrombolysis treatment with alteplase (Actilyse) of acute ischemic stroke with 24-hour in-house neurology coverage and use of magnetic resonance imaging.
A health economic model was designed to calculate the marginal cost-effectiveness ratios for time spans of 1, 2, 3 and 30 years. Effect data were extracted from a meta-analysis of six large-scale randomized and placebo-controlled studies of thrombolytic therapy with alteplase. Cost data were extracted from thrombolysis treatment at Aarhus Hospital, Denmark, and from previously published literature.
The calculated cost-effectiveness ratio after the first year was $55,591 US per quality-adjusted life-year (base case). After the second year, computation of the cost-effectiveness ratio showed that thrombolysis was cost-effective. The long-term computations (30 years) showed that thrombolysis was a dominant strategy compared with conservative treatment given the model premises.
A high-quality thrombolysis treatment with 24-hour in-house neurology coverage and magnetic resonance imaging might not be cost-effective in the short term compared with conservative treatment. In the long term, there are potentially large-scale health economic cost savings.
PubMed ID
17122430 View in PubMed
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The cost-effectiveness of magnetic resonance imaging for patients with internal derangement of the knee.

https://arctichealth.org/en/permalink/ahliterature200705
Source
Int J Technol Assess Health Care. 1999;15(2):392-405
Publication Type
Article
Date
1999
Author
M E Suarez-Almazor
P. Kaul
C J Kendall
L D Saunders
D W Johnston
Author Affiliation
University of Alberta.
Source
Int J Technol Assess Health Care. 1999;15(2):392-405
Date
1999
Language
English
Publication Type
Article
Keywords
Adult
Alberta
Arthroscopy - economics
Cost-Benefit Analysis
Direct Service Costs - statistics & numerical data
Female
Humans
Knee Injuries - diagnosis - surgery
Magnetic Resonance Imaging - economics - standards
Male
Middle Aged
Reproducibility of Results
Retrospective Studies
Sensitivity and specificity
Unnecessary Procedures - economics
Abstract
Magnetic resonance imaging (MRI) has excellent specificity and sensitivity for the diagnosis of internal derangement of the knee (IDK). The use of MRI to screen patients with suspected IDK could avoid unnecessary arthroscopies with a reduction in costs. The purpose of this study was to evaluate the use of arthroscopy among patients with IDK, and to estimate the potential cost-effectiveness of MRI in these patients to avoid unnecessary arthroscopies. The study was based on a retrospective cohort of all patients attending three orthopedic clinics between April and September 1993 with a new diagnosis of IDK. Charts were reviewed in 1994 to allow for a follow-up of more than 6 months. An economic evaluation was performed based on cost-effectiveness ratios (per averted arthroscopy), including direct and indirect costs. There were 241 patients with a new diagnosis of IDK (67% males, mean age 35 +/- 12 years), and 110 (46%) underwent arthroscopy. The remaining patients received conservative therapy and were not scheduled for arthroscopy within the period of observation. Using a priori established criteria, 10% of the arthroscopies could be considered diagnostic only (e.g., normal knee) and 27% were of doubtful efficacy from a therapeutic perspective (e.g., debridement alone). Many of these arthroscopies could have been avoided by performing a prior MRI. Using these findings, we conducted decision tree analyses of the use of MRI among patients requiring arthroscopy of the knee. A sensitivity analysis was performed to evaluate the various model assumptions. In general, MRI appeared to be a cost-effective diagnostic procedure for patients with IDK requiring arthroscopy of the knee, and there were cost savings associated with it in some of the models tested.
PubMed ID
10507197 View in PubMed
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Cost-effectiveness of MRI for breast cancer screening in BRCA1/2 mutation carriers.

https://arctichealth.org/en/permalink/ahliterature108825
Source
BMC Cancer. 2013;13:339
Publication Type
Article
Date
2013
Author
Reka Pataky
Linlea Armstrong
Stephen Chia
Andrew J Coldman
Charmaine Kim-Sing
Barbara McGillivray
Jenna Scott
Christine M Wilson
Stuart Peacock
Author Affiliation
Cancer Control Research, BC Cancer Agency, 675 W, 10th Ave, Vancouver, BC V5Z 1L3, Canada.
Source
BMC Cancer. 2013;13:339
Date
2013
Language
English
Publication Type
Article
Keywords
Breast Neoplasms - diagnosis - economics - genetics
Canada
Cost-Benefit Analysis
Early Detection of Cancer - economics - methods
Genes, BRCA1
Genes, BRCA2
Humans
Magnetic Resonance Imaging - economics
Mammography - economics
Markov Chains
Mutation
Quality-Adjusted Life Years
Abstract
Women with mutations in BRCA1 or BRCA2 are at high risk of developing breast cancer and, in British Columbia, Canada, are offered screening with both magnetic resonance imaging (MRI) and mammography to facilitate early detection. MRI is more sensitive than mammography but is more costly and produces more false positive results. The purpose of this study was to calculate the cost-effectiveness of MRI screening for breast cancer in BRCA1/2 mutation carriers in a Canadian setting.
We constructed a Markov model of annual MRI and mammography screening for BRCA1/2 carriers, using local data and published values. We calculated cost-effectiveness as cost per quality-adjusted life-year gained (QALY), and conducted one-way and probabilistic sensitivity analysis.
The incremental cost-effectiveness ratio (ICER) of annual mammography plus MRI screening, compared to annual mammography alone, was $50,900/QALY. After incorporating parameter uncertainty, MRI screening is expected to be a cost-effective option 86% of the time at a willingness-to-pay of $100,000/QALY, and 53% of the time at a willingness-to-pay of $50,000/QALY. The model is highly sensitive to the cost of MRI; as the cost is increased from $200 to $700 per scan, the ICER ranges from $37,100/QALY to $133,000/QALY.
The cost-effectiveness of using MRI and mammography in combination to screen for breast cancer in BRCA1/2 mutation carriers is finely balanced. The sensitivity of the results to the cost of the MRI screen itself warrants consideration: in jurisdictions with higher MRI costs, screening may not be a cost-effective use of resources, but improving the efficiency of MRI screening will also improve cost-effectiveness.
Notes
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PubMed ID
23837641 View in PubMed
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Diagnosis of meningeoma. A comparison of costs before CT, during CT and after introduction of MR imaging.

https://arctichealth.org/en/permalink/ahliterature20120
Source
Acta Radiol. 2000 Nov;41(6):539-43
Publication Type
Article
Date
Nov-2000
Author
J. Laurila
I. Suramo
M. Brommels
A. Servo
J. Kotikangas
C G Standertskjöld-Nordenstam
Author Affiliation
Department of Radiology, Oulu University Central Hospital, Finland.
Source
Acta Radiol. 2000 Nov;41(6):539-43
Date
Nov-2000
Language
English
Publication Type
Article
Keywords
Costs and Cost Analysis
Europe
Female
Humans
Length of Stay
Magnetic Resonance Imaging - economics
Male
Meningeal Neoplasms - diagnosis - economics
Meningioma - diagnosis - economics
Middle Aged
Tomography, X-Ray Computed - economics
Abstract
OBJECTIVE: To assess whether the capital investment required by advances in radiological technology is offset by savings in the direct costs of diagnostic services. MATERIAL AND METHODS: Meningeoma was used as an indicator case. All meningeoma patients from three study periods were included: Twenty patients in 1976-77 before the introduction of CT, 22 patients in 1984-85 when CT was used and 16 patients in 1992 when MR imaging had replaced CT as the most informative imaging modality. Radiological and other diagnostic investigations, and the hospital stay were identified and cost analyzed. RESULTS: The costs of radiological examinations increased from 293 Euros in 1976-77 to 513 Euros in 1992. The average number of diagnostic examinations per patient decreased from 5.1 in 1976 77 to 2.4 in 1992. The length of hospital stay decreased from 11.5 to 2.7 days and the total costs of the diagnostic work-up decreased to one-third of the original, i.e. from 3423 Euros in 1976-77 to 1282 Euros in 1992. CONCLUSION: The costs of the radiological examinations rose, but the development of radiological technology simplified the diagnostic practice. The hospital stay drastically decreased. The total costs of diagnostic work-up per patient dropped to one-third of the baseline costs.
PubMed ID
11092472 View in PubMed
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Diagnostic evaluation in patients with intractable epilepsy and normal findings on MRI: a decision analysis and cost-effectiveness study.

https://arctichealth.org/en/permalink/ahliterature116494
Source
AJNR Am J Neuroradiol. 2013 May;34(5):1004-9, S1-2
Publication Type
Article
Date
May-2013
Author
E. Widjaja
B. Li
L Santiago Medina
Author Affiliation
Diagnostic Imaging and Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada. Elysa.Widjaja@sickkids.ca
Source
AJNR Am J Neuroradiol. 2013 May;34(5):1004-9, S1-2
Date
May-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Chronic Disease
Cost-Benefit Analysis
Decision Support Systems, Clinical
Decision Support Techniques
Epilepsy - diagnosis - economics - mortality
Female
Health Care Costs
Humans
Magnetic Resonance Imaging - economics - utilization
Magnetoencephalography - economics - statistics & numerical data
Male
Middle Aged
Ontario
Prevalence
Radionuclide Imaging - economics - utilization
Reproducibility of Results
Risk assessment
Sensitivity and specificity
Survival Analysis
Survival Rate
Abstract
Patients with focal intractable epilepsy and normal MR imaging findings frequently undergo further diagnostic tests to localize the epileptogenic zone. The aim of this study was to determine the cost-effective diagnostic strategy that will identify the epileptogenic zone in patients with suspected focal intractable epilepsy and normal MR imaging findings by using decision analysis.
A Markov decision model was constructed by using sensitivities and specificities of test strategies, seizure outcomes following surgical and medical treatment, cost, utilities, probabilities, and standardized mortality ratios. We compared 6 diagnostic test strategies: PET, ictal SPECT, and MEG individually; and combinations of PET+SPECT, PET+MEG, and SPECT+MEG. The outcomes measured were health care costs, QALY, and ICER. One-way and probabilistic sensitivity analyses were conducted to adjust for uncertainties in model parameters.
The preferred strategies were PET+MEG and SPECT. The health care cost of the baseline strategy (PET+MEG) was $95,612 with 16.30 QALY gained. SPECT cost $97,479 with 16.45 QALY gained and an ICER of $12,934/QALY gained compared with those in PET+MEG. One-way sensitivity analyses showed that the decisions of the model were sensitive to variations in sensitivity and specificity of the test strategies. Probabilistic sensitivity analysis showed that when the willingness to pay was $10,000.
PET+MEG and SPECT were the preferred strategies in the base case. The choice of test was dependent on the sensitivity and specificity of test strategies and willingness to pay. Further study with a larger sample size is needed to obtain better estimates of sensitivity and specificity of diagnostic tests.
PubMed ID
23391843 View in PubMed
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Health economic aspects of evaluation with diffusion weighted MR and MR colonography compared to standard evaluation with colonoscopy and CT before rectal cancer surgery.

https://arctichealth.org/en/permalink/ahliterature281550
Source
Acta Radiol. 2017 Apr;58(4):435-441
Publication Type
Article
Date
Apr-2017
Author
Michael P Achiam
Jakob Kjellberg
Jacob Rosenberg
Source
Acta Radiol. 2017 Apr;58(4):435-441
Date
Apr-2017
Language
English
Publication Type
Article
Keywords
Colon - diagnostic imaging
Colonoscopy - economics
Cost-Benefit Analysis - economics
Denmark
Diffusion Magnetic Resonance Imaging - economics
Humans
Magnetic Resonance Imaging - economics
Rectal Neoplasms - diagnostic imaging - economics - surgery
Sensitivity and specificity
Tomography, X-Ray Computed - economics
Abstract
Background Colorectal cancer is a frequent type of cancer, and with the risk of synchronous disease, the need for a complete staging leads to an extensive and costly preoperative diagnostic evaluation. Previously we described a total preoperative evaluation using magnetic resonance (MR) colonography and diffusion-weighted MR of the liver. Purpose To compare the economic aspects of this modality with the standard evaluation in an analysis of the different cost drivers. Material and Methods Based on the results from previous studies, two calculations were performed, a theoretical cost calculation and a practical cost calculation. The cost drivers utilized are an average cost based on the cost of all procedures and diagnostic modalities performed in hospitalized patients (DRG) and outpatients (DAGS [Danish outpatient grouping system]) in Denmark. Results The total cost for a full colorectal evaluation and computed tomography (CT) scan of the thorax/abdomen was less for the new modality group in all theoretical models proposed; ?225 using model A, ?322 using model B, and ?383 using model C. Using results from previous studies, the actual difference and the potential difference in cost between the two preoperative diagnostic modalities per patient were ?312 and ?712, respectively. Conclusion This cost analysis shows the cost effectiveness of the new modality as the future standard preoperative diagnostic work-up by reducing total cost and by having a higher sensitivity and completion rate.
PubMed ID
27307026 View in PubMed
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24 records – page 1 of 3.