The Cost of Diagnosis

摘要: Introduction Due to the large numbers of negative results sputum examinations in face malignant disease, we used a decision analytic model determine whether, and under what conditions, cytology (Spt) might have cost-effective role play approach lung lesions. Methods We constructed compare utility Spt, image-directed fine-needle aspiration (FNA), bronchoscopic examination (Bronch), open biopsy (OBx) evaluation Prevalence cost data were derived from local databases diagnosis-related groups. Diagnostic sensitivity (sens) specificity (spec) tests literature data. Output was lowest per correct diagnosis included surgical treatment costs. did not attempt survival or morbidity. Sensitivity analyses performed using cost, test sensitivity, lesion size variables. Results In baseline case, patient who is candidate with 2.8 cm, prevalence malignancy=0.67, FNA sens=0.95, Bronch sens=0.80, Spt sens=0.51, OBx best initial procedure $12,888. Sputum has highest $63,424. bronchoscopy $21,543 $16,615, respectively. Sens analysis shows that preferred strategy workup lesions patients are candidates older than 30 years age. only when candidate, (>4.7 cm), if sens >0.45. Conclusions clinical practice, except clinically unresectable laboratory can demonstrate sufficient sens.