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10.1001/jamainternmed.2017.0739 http://scihub22266oqcxt.onion/10.1001/jamainternmed.2017.0739 C5818826!5818826 !28418451     free     free     free Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 245.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 245.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Warning: imagejpeg(C:\Inetpub\vhosts\kidney.de\httpdocs\phplern\28418451 .jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117       JAMA+Intern+Med 2017 ; 177 (6 ): 800-807 Nephropedia Template TP {{tp|p=28418451 |t=2017. Cost-effectiveness of Common Diagnostic Approaches for Evaluation of Asymptomatic Microscopic Hematuria |pdf=|usr=}}{{28418451 }} gab.com Text Cost-effectiveness of Common Diagnostic Approaches for Evaluation of Asymptomatic Microscopic Hematuria JO: JAMA Intern Med http://www.kidney.de/pget.php?&tw=1&pmid=28418451 #FOAvip IMPORTANCE: Asymptomatic microscopic hematuria (AMH) is highly prevalent and may signal occult genitourinary (GU) malignant abnormality. Common diagnostic approaches differ in their costs and effectiveness in detecting cancer. Given the low prevalence of GU malignant abnormality among patients with AMH, it is important to quantify the cost implications of detecting cancer for each approach. OBJECTIVE: To estimate the effectiveness, costs, and incremental cost per cancer detected (ICCD) for 4 common diagnostic approaches evaluating AMH. DESIGN, SETTING, AND PARTICIPANTS: A decision-analytic model-based cost-effectiveness analysis using inputs from the medical literature. PubMed searches were performed to identify relevant literature for all key model inputs, each of which was derived from the clinical study with the most robust data and greatest applicability. Analysis included adult patients with AMH on routine urinalysis with subgroups of high-risk patients (males, smokers, age ?50 years) seen in the primary care or urologic referral setting. INTERVENTIONS: Four diagnostic approaches were evaluated relative to the reference case of no evaluation: (1) computed tomography (CT) alone; (2) cystoscopy alone; (3) CT and cystoscopy combined; and (4) renal ultrasound and cystoscopy combined. MAIN OUTCOMES AND MEASURES: At termination of the diagnostic period, cancers detected, costs (payer perspective), and ICCD per 10?000 patients evaluated for AMH. RESULTS: Of the 4 diagnostic approaches analyzed, CT alone was dominated by all other strategies, detecting 221 cancers at a cost of $9?300?000. Ultrasound and cystoscopy detected 245 cancers and was most cost-effective with an ICCD of $53?810. Replacing ultrasound with CT detected just 1 additional cancer at an ICCD of $6?480?484. Ultrasound and cystoscopy remained the most cost-effective approach in subgroup analysis. The model was not sensitive to any inputs within the proposed ranges. Using probabilistic sensitivity analysis, ultrasound and cystoscopy was the dominant strategy in 100% of simulations. CONCLUSIONS AND RELEVANCE: The combination of renal ultrasound and cystoscopy is the most cost-effective among 4 diagnostic approaches for the initial evaluation of AMH. The use of ultrasound in lieu of CT as the first-line diagnostic strategy will optimize cancer detection and reduce costs associated with evaluation of AMH. Given our findings, we need to critically evaluate the appropriateness of our current clinical practices, and potentially alter our guidelines to reflect the most effective screening strategies for patients with AMH. Twit Text FOAVip Cost-effectiveness of Common Diagnostic Approaches for Evaluation of Asymptomatic Microscopic Hematuria ????JAMA Intern Med http://www.kidney.de/pget.php?&tw=1&pmid=28418451 #FOAvip Twit Text # Free Paper on # # # # # LINK http://www.kidney.de/pget.php?&tw=1&pmid=28418451 #FOAvip English Wikipedia <ref>{{Cite pmid|28418451 }}</ref> Cost-effectiveness of Common Diagnostic Approaches for Evaluation of Asymptomatic Microscopic Hematuria #MMPMID28418451 Halpern JA ; Chughtai B ; Ghomrawi H JAMA Intern Med 2017[Jun]; 177 (6 ): 800-807 PMID28418451 show ga IMPORTANCE: Asymptomatic microscopic hematuria (AMH) is highly prevalent and may signal occult genitourinary (GU) malignant abnormality. Common diagnostic approaches differ in their costs and effectiveness in detecting cancer. Given the low prevalence of GU malignant abnormality among patients with AMH, it is important to quantify the cost implications of detecting cancer for each approach. OBJECTIVE: To estimate the effectiveness, costs, and incremental cost per cancer detected (ICCD) for 4 common diagnostic approaches evaluating AMH. DESIGN, SETTING, AND PARTICIPANTS: A decision-analytic model-based cost-effectiveness analysis using inputs from the medical literature. PubMed searches were performed to identify relevant literature for all key model inputs, each of which was derived from the clinical study with the most robust data and greatest applicability. Analysis included adult patients with AMH on routine urinalysis with subgroups of high-risk patients (males, smokers, age ?50 years) seen in the primary care or urologic referral setting. INTERVENTIONS: Four diagnostic approaches were evaluated relative to the reference case of no evaluation: (1) computed tomography (CT) alone; (2) cystoscopy alone; (3) CT and cystoscopy combined; and (4) renal ultrasound and cystoscopy combined. MAIN OUTCOMES AND MEASURES: At termination of the diagnostic period, cancers detected, costs (payer perspective), and ICCD per 10?000 patients evaluated for AMH. RESULTS: Of the 4 diagnostic approaches analyzed, CT alone was dominated by all other strategies, detecting 221 cancers at a cost of $9?300?000. Ultrasound and cystoscopy detected 245 cancers and was most cost-effective with an ICCD of $53?810. Replacing ultrasound with CT detected just 1 additional cancer at an ICCD of $6?480?484. Ultrasound and cystoscopy remained the most cost-effective approach in subgroup analysis. The model was not sensitive to any inputs within the proposed ranges. Using probabilistic sensitivity analysis, ultrasound and cystoscopy was the dominant strategy in 100% of simulations. CONCLUSIONS AND RELEVANCE: The combination of renal ultrasound and cystoscopy is the most cost-effective among 4 diagnostic approaches for the initial evaluation of AMH. The use of ultrasound in lieu of CT as the first-line diagnostic strategy will optimize cancer detection and reduce costs associated with evaluation of AMH. Given our findings, we need to critically evaluate the appropriateness of our current clinical practices, and potentially alter our guidelines to reflect the most effective screening strategies for patients with AMH. |Aged [MESH] |Algorithms [MESH] |Cost-Benefit Analysis [MESH] |Diagnostic Tests, Routine/*economics/standards [MESH] |Evidence-Based Medicine [MESH] |Female [MESH] |Hematuria/complications/*diagnosis/*economics/urine [MESH] |Humans [MESH] |Male [MESH] |Middle Aged [MESH]Cost-effectiveness of Common Diagnostic Approaches for Evaluation of A(epmc).pdf DeepDyve Pubget Overpricing