Unenhanced CT together with MR imaging is the most cost-effective strategy for evaluating an adrenal mass in patients with lung carcinoma, according to a study in this month's issue of the American Journal of Roentgenology.
Researchers from various departments of the Cleveland Clinic Foundation in Ohio tested nine different strategies to evaluate adrenal masses in cases of newly diagnosed non-small cell carcinoma. Strategies one and three used unenhanced CT using 0 H as a threshold and then an MR scan as a follow-up. Strategies two and four used unenhanced CT with 10 H as a threshold, followed up with MRI. Finally, strategies five through seven used MRI first and then CT. Strategies seven through nine did not use imaging at all and went straight to surgery (April 2000, Volume 174:4, pp. 1033-1039.)
"If an adenoma is confirmed, then resection occurs. If adenoma is not confirmed by the second noninvasive test, then percutaneous CT-guided biopsy is performed," the authors explained.
Medicare reimbursement was used as a surrogate for cost. According to the baseline analysis, CT followed by MRI, if necessary, was the most cost-effective; CT with a threshold of 0 H followed by biopsy was the least costly. The incremental cost effectiveness ratio between the two strategies was $16,370 per year of life gained.
"From a strict decision-analysis approach, one strategy is the most cost-effective, but the differences in cost-effectiveness are moderate. One could argue that from a practical standpoint, other issues should be considered. For instance, local practice patterns, examination charges, or patient preference may impact these choices," the authors said.
To view original article, visit http://www.ajronline.org/cgi/content/full/174/4/1033
By Shalmali Pal
AuntMinnie.com staff writer
April 25, 2000
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