This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.

Preoperative routine chest radiography in patients with early stage prostatic carcinoma.

Diagnosis.

Cost-effectiveness analysis.

Asymptomatic patients with prostatic carcinoma detected in a specific antigen screening programme. The age range was 50-84 years (median and mean of 67 years). The mean PSA level was 12 ng, with a SD of 15 and a median of 7 ng, with a range of 2.9 to 152 ng.

Hospital-based outpatients. The economic study was carried out in Washington, USA.

Effectiveness data were collected from June 1989 to April 1992. Resource data related to the same period. No charge/cost date was specified.

Single study.

The costing was undertaken retrospectively on the same patient sample used in the effectiveness analysis.

Of a total sample of 497 patients screened. A subsample of 292 patients constituted the basis for the analysis since they had retrievable original chest radiograph reports. No power calculations were reported.

Retrospective case series, single centre study. There was no loss to follow-up. Duration of follow-up was not specified.

Clinical effectiveness was evaluated in terms of the number of true positive abnormal findings and the consequent impact on the planned disease management. The analysis was based on'treatment completers' only.

Forty-three patients (15%) had positive chest radiographic results, with a total of 45 abnormal findings. For two of these patients the findings had a significant clinical impact on the planned disease management, since one patient had a lymphoma and therefore did not undergo the retropubic radical prostatectomy, and the other had a bronchoalveolar cell carcinoma.

Routine pre-operative chest radiography makes earlier detection of potentially lethal diseases possible.

True positive abnormal findings and consequent impact on the planned disease management.

Some costs and quantities were reported separately. Costs to the provider organisations were considered, including: cost of chest radiographs, cost of follow-up imaging/analysis, cost of non-US dollars ($).surgical and surgical procedures. Costs were based on Medicare reimbursement. No price date was given.

US dollars ($).

The cost analysis was also performed using physician and hospital charges.

Forty-three patients (15%) had positive chest radiographic results, with a total of 45 abnormal findings. For two of these patients, the findings had a significant clinical impact on the planned disease management, since one patient had a lymphoma and therefore did not undergo the retropubic radical prostatectomy, and the other had a bronchoalveolar cell carcinoma.

Based on Medicare reimbursements, the total cost of performing pre-operative chest radiographs was $10,632.16, while the additional cost sustained if no radiographs were undertaken was $8,543.13 (i.e. the cost of the retropubic radical prostatectomy avoided). Therefore, the incremental cost of the routine use of preoperative chest radiographs was $2,089.03. If based on physician and hospital charges instead of Medicare reimbursement, the incremental cost of the programme would be $13,954.

A synthesis was not performed.

The authors concluded that in this study it was not possible to determine the cost-effectiveness of routine chest radiography given the small size of the sample and the methodological difficulty of measuring the benefits.

A chest radiography investigation may provide very useful information about the general health status of patients. This is particularly true for elderly patients who may have developed further diseases beyond those already detected. For this reason, routine chest radiography is required by pre-operative protocols performed in most developed countries. However, the cost-effectiveness of this procedure should be evaluated for subgroups of populations. This study represents a preliminary investigation to address this issue. As the authors themselves recognise, the analysis of effectiveness should be assessed in a more rigorous way.

Further research would be useful to evaluate the outcomes of the preoperative routine chest radiography.