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Titolo:
COST IMPLICATIONS OF SELECTIVE PREOPERATIVE RISK SCREENING IN THE CARE OF CANDIDATES FOR PERIPHERAL-VASCULAR OPERATIONS
Autore:
SHAW LJ; HACHAMOVITCH R; COHEN M; BERMAN DS; BORGESNETO S; UDELSON JE; HELLER GV; EISENSTEIN EL; EAGLE KA; HENDEL RC; MILLER DD;
Indirizzi:
CTR CLIN EVALUAT SCI,PROGRAM CARDIOVASC HLTH SERV RES,ROOM 638,GRACE CRUM ROLLINS BLDG ATLANTA GA 30322 EMORY UNIV,DIV CARDIOL ATLANTA GA 30322 CORNELL MED CTR NEW YORK NY 00000 BETH ISRAEL DEACONESS HOSP BOSTON MA 00000 CEDARS SINAI MED CTR LOS ANGELES CA 90048 DUKE UNIV,MED CTR DURHAM ENGLAND TUFTS UNIV NEW ENGLAND MED CTR BOSTON MA 02111 HARTFORD HOSP HARTFORD CT 06115 UNIV MICHIGAN ANN ARBOR MI 48109 NORTHWESTERN UNIV,MED CTR CHICAGO IL 60611 ST LOUIS UNIV,CTR HLTH SCI ST LOUIS MO 63103
Titolo Testata:
American journal of managed care
fascicolo: 12, volume: 3, anno: 1997,
pagine: 1817 - 1827
SICI:
1096-1860(1997)3:12<1817:CIOSPR>2.0.ZU;2-N
Fonte:
ISI
Lingua:
ENG
Soggetto:
DOBUTAMINE STRESS ECHOCARDIOGRAPHY; DIPYRIDAMOLE-THALLIUM SCINTIGRAPHY; CORONARY-ARTERY DISEASE; ABDOMINAL AORTIC-ANEURYSM; ISCHEMIC-HEART-DISEASE; CARDIAC RISK; PREDICTIVE VALUE; MYOCARDIAL-INFARCTION; NONCARDIAC SURGERY; MANAGEMENT;
Tipo documento:
Article
Natura:
Periodico
Citazioni:
40
Recensione:
Indirizzi per estratti:
Citazione:
L.J. Shaw et al., "COST IMPLICATIONS OF SELECTIVE PREOPERATIVE RISK SCREENING IN THE CARE OF CANDIDATES FOR PERIPHERAL-VASCULAR OPERATIONS", American journal of managed care, 3(12), 1997, pp. 1817-1827

Abstract

The preoperative identification that patients are at high risk for adverse postoperative outcomes is the first-step toward preventing costly in-hospital complications. The economic implications of noninvasive screening strategies in the care of patients undergoing peripheral vascular operations must be clarified. A decision model was developed from the peer-reviewed literature on patients undergoing preoperative screening by means of dipyridamole myocardial perfusion imaging, dobutamine echocardiography, or cardiac catheterization before vascular operations (n = 23 studies). Routine versus selective screening strategies were compared for patients with an intermediate likelihood of having coronary artery disease on the basis of clinical history of coronary disease or typical symptoms. Median costs (1994 US dollars) of preoperative screening strategies were derived with two microcosting approaches:adjusted Medicare charges (top-down approach) and a bottom-up approach with Duke University Medical Center direct cost estimate data. In-hospital cost was 11% higher for preoperative screening by means of routine cardiac catheterization ($27,760) than for routine pharmacologic stress imaging ($24,826, P = 0.001). The total cost of a do-nothing strategy, that is, no preoperative testing, was 5.9% less than that of routine preoperative pharmacologic stress imaging and 15.9% lower than that of cardiac catheterization (P = 0.001). Selective screening among patients with a history of coronary disease or typical angina resultedin further reduction of the cost of care to a level comparable with that of a do-nothing strategy (52.5% reduction in cost with pharmacologic stress imaging, P > 0.20). Use of noninvasive testing for preoperative risk stratification was cost,effective for patients 60 to 80 yearsof age. Cost per life saved ranged from $33,338 to $21,790. However, coronary revascularization after an abnormal noninvasive test was costeffective only for patients older-than 70 years. In this economic-decision model, substantial cost savings were predicted when selective noninvasive stress imaging was added to preoperative screening for patients about to undergo vascular operations. With a selective screening approach, the economic impact of initial diagnostic testing may be minimized without compromising patient outcomes.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 06/04/20 alle ore 11:20:46