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Titolo:
Finding cancer in primary care outpatients with low back pain - A comparison of diagnostic strategies
Autore:
Joines, JD; McNutt, RA; Carey, TS; Deyo, TA; Rouhani, R;
Indirizzi:
Moses H Cone Mem Hosp, Internal Med Training Program, Greensboro, NC 27401USA Moses H Cone Mem Hosp Greensboro NC USA 27401 am, Greensboro, NC 27401USA Univ N Carolina, Cecil G Sheps Ctr Hlth Serv Res, Chapel Hill, NC USA UnivN Carolina Chapel Hill NC USA tr Hlth Serv Res, Chapel Hill, NC USA Univ N Carolina, Dept Med, Chapel Hill, NC USA Univ N Carolina Chapel Hill NC USA rolina, Dept Med, Chapel Hill, NC USA Cook Cty Hosp, Dept Med, Chicago, IL 60612 USA Cook Cty Hosp Chicago IL USA 60612 Hosp, Dept Med, Chicago, IL 60612 USA Univ Washington, Dept Med, Seattle, WA USA Univ Washington Seattle WA USA niv Washington, Dept Med, Seattle, WA USA Univ Washington, Dept Hlth Serv, Seattle, WA 98195 USA Univ Washington Seattle WA USA 98195 ept Hlth Serv, Seattle, WA 98195 USA Univ Washington, Ctr Cost & Outcomes Res, Seattle, WA 98195 USA Univ Washington Seattle WA USA 98195 Outcomes Res, Seattle, WA 98195 USA Univ Texas, Hlth Sci Ctr, Ctr Distance Learning & Telehlth, San Antonio, TX USA Univ Texas San Antonio TX USA e Learning & Telehlth, San Antonio, TX USA
Titolo Testata:
JOURNAL OF GENERAL INTERNAL MEDICINE
fascicolo: 1, volume: 16, anno: 2001,
pagine: 14 - 23
SICI:
0884-8734(200101)16:1<14:FCIPCO>2.0.ZU;2-E
Fonte:
ISI
Lingua:
ENG
Soggetto:
COST-EFFECTIVENESS ANALYSIS; RADIONUCLIDE BONE SCANS; SPINAL-CORD COMPRESSION; COMPUTED-TOMOGRAPHY; VERTEBRAL BIOPSY; GUIDED BIOPSY; METASTASES; ECONOMICS; SURVIVAL; PATIENT;
Keywords:
low back pain; decision analysis; cost-effectiveness analysis;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
45
Recensione:
Indirizzi per estratti:
Indirizzo: Joines, JD Moses H Cone Mem Hosp, Internal Med Training Program, 1200 N Elm St, Greensboro, NC 27401 USA Moses H Cone Mem Hosp 1200 N Elm St Greensboro NC USA 27401 USA
Citazione:
J.D. Joines et al., "Finding cancer in primary care outpatients with low back pain - A comparison of diagnostic strategies", J GEN INT M, 16(1), 2001, pp. 14-23

Abstract

OBJECTIVE: To compare strategies for diagnosing cancer in primary care patients with low back pain. Strategies differed in their use of clinical findings, erythrocyte sedimentation rate (ESR), and plain x-rays prior to imaging and biopsy. DESIGN: Decision analysis and cost effectiveness analysis with sensitivityanalyses. Strategies were compared in terms of sensitivity, specificity, and diagnostic coat effectiveness ratios. SETTING: Hypothetical. MEASUREMENTS: Estimates of disease prevalence and test characteristics were taken from the literature. Costs were represented by the Medicare reimbursement for the tests and procedures employed. MAIN RESULTS: In the baseline analysis, using magnetic resonance imaging (MRI) as the imaging procedure prior to a single biopsy, strategies ranged in sensitivity from 0.40 to 0.73, with corresponding diagnostic coats of $14to $241 per patient and average cost effectiveness ratios of $5,283 to $49,814 per case of cancer found. Incremental cost effectiveness ratios variedfrom $8,397 to $624,781; five strategies were dominant in the baseline analysis. Use of a higher ESR cutoff point (50 mm/hr) improved specificity andcost effectiveness for certain strategies, Imaging with MRI, or bone scan followed in series by MRI, resulted in fewer unnecessary biopsies than imaging with bone scan alone. Cancer prevalence was an important determinant ofcost effectiveness. CONCLUSIONS: We: recommend a strategy of imaging patients who have a clinical finding (history of cancer, age greater than or equal to 50 years, weight loss. or failure to improve with conservative therapy) in combination with either an elevated ESR (greater than or equal to 50 mm/hr) or a positivex-ray, or using the same approach but imaging directly those patients witha history of cancer.

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Documento generato il 18/01/21 alle ore 15:59:16