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Ultrasound-guided fine-needle aspiration biopsy: study of the cost per patient and comparison with computed tomography-guided biopsy |
Garre C, Sola J, Bas A, Mercader J, Lopez-Alanis A |
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Record Status 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. Health technology Ultrasound-guided fine needle aspiration biopsy (FNAB) in abdominal space-occupying lesions.
Economic study type Cost-effectiveness analysis.
Study population Patients with abdominal lesions.
Setting Hospital. The economic study was carried out in Murcia, Spain.
Dates to which data relate The resource use and effectiveness data corresponding to the intervention were collected between March 1992 and August 1995. The effectiveness data for the comparator were obtained from a review of studies published in 1983, 1984, and 1994. The price year was not reported.
Source of effectiveness data Effectiveness data were derived from a single study and review of previously completed studies.
Link between effectiveness and cost data The costing was undertaken retrospectively based on the same patient sample as that used in the effectiveness analysis.
Study sample Power calculations were not used to determine the sample size. A total of 222 patients was included in the analysis. The mean age of patients in the intervention group was 62 years, with 68.5% being men. Liver lesions accounted for 72.5% of the total, whereas pancreatic lesions, fluid collections and retroperitoneal lymph nodes made up 10.8%, 6.7% and 4.0%, respectively.
Study design This was a case series, carried out in a single centre. No duration of follow-up or loss to follow up was reported.
Analysis of effectiveness The principle (intention to treat or treatment completers only) used in the analysis of effectiveness was not explicitly specified. The primary health outcomes used in the analysis were the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall diagnostic accuracy of ultrasound-guided FNABs.
Effectiveness results The sensitivity of ultrasound-guided FNABs was 90%; specificity, 100%; positive predictive value, 100%; negative predictive value, 81%; overall diagnostic accuracy, 93%.
Outcomes assessed in the review The sensitivity, and diagnostic accuracy of CT-guided FNABs were the outcomes assessed in the review.
Study designs and other criteria for inclusion in the review One case series was reported, but no details were given about the other four studies included in the review.
Sources searched to identify primary studies Criteria used to ensure the validity of primary studies Methods used to judge relevance and validity, and for extracting data Number of primary studies included Five studies were included in the review to assess the outcomes related to the CT-guided FNABs.
Methods of combining primary studies Investigation of differences between primary studies Results of the review The sensitivity of CT-guided biopsy had a range of values from 85% to 95%. Its diagnostic accuracy had values between 75% and 92%.
Measure of benefits used in the economic analysis The benefit measure was diagnostic yields.
Direct costs Costs were not discounted. The quantities of resource use were reported separately from the prices. The costs measured were those associated with capital (equipment), operating (staff) and overheads (maintenance). The cost estimation was based on actual data from the institution. The comparator=s capital cost data were collected during the period from January 1993 to June 1995. The price year was not reported. Costs associated with electricity, in the comparator=s case, were omitted from the analysis. Also, the costs associated with disposals were excluded from the analysis due to the difficulty in measuring them, while the authors considered them as common to both modalities.
Estimated benefits used in the economic analysis The authors considered the two modalities to have similar diagnostic yields.
Cost results The cost per ultrasound guided-FNAB was Pta2,550, whereas the cost of CT-guided FNAB was Pta22,502.
Synthesis of costs and benefits Costs and benefits were not combined since the use of ultrasound guided-FNAB in the context in question was the weakly dominant strategy (with equal efficacy and lower costs).
Authors' conclusions Both the results from the study and the literature show that, for abdominal lesions, no significant differences exist in diagnostic yield between the CT guided and the ultrasound-guided FNAB, but that the difference in terms of cost is considerable. The authors consider that CT-guided FNAB should be reserved for the study of those abdominal lesions that are not accessible to ultrasound.
CRD COMMENTARY - Selection of comparators The reason for the choice of the comparator is clear.
Validity of estimate of measure of benefit The internal validity of the study results cannot be fully guaranteed given the biases accompanying the study design employed in the investigation. In addition, the quality of the literature search used for the estimation of the comparator=s effectiveness cannot be objectively assessed given the limited information provided in the study.
Validity of estimate of costs The resource use quantities were reported separately from the prices and adequate details were provided regarding the methods of cost estimation (the exception being the price year used in the analysis, which was not provided). The cost of disposables was omitted from the analysis and also that corresponding to electricity used in the comparator.
Other issues Although the comparison with previous studies was considered to be in accordance with the present study findings, the generalisability of the study results was not further discussed. The results were also presented separately for liver and pancreas lesions. Overall, the results need to be treated with some caution given the lack of a prospective design, a comprehensive literature review, sensitivity analysis, and statistical analysis of the costs.
Bibliographic details Garre C, Sola J, Bas A, Mercader J, Lopez-Alanis A. Ultrasound-guided fine-needle aspiration biopsy: study of the cost per patient and comparison with computed tomography-guided biopsy. Revista Espanola de Enfermedades Digestivas 1997; 89(4): 301-304 Indexing Status Subject indexing assigned by NLM MeSH Adult; Aged; Aged, 80 and over; Biopsy, Needle /economics /methods; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Tomography, X-Ray Computed /economics; Ultrasonography /economics AccessionNumber 21997000783 Date bibliographic record published 30/04/2000 Date abstract record published 30/04/2000 |
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