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Del Blanco Alonso I, Revilla Calavia Á, Saiz-Viloria L, Diez Martínez M, San Norberto García E, Vaquero Puerta C. Cost-effectiveness analysis of the diagnosis of temporal arteritis. Reumatol Clin (Engl Ed) 2024; 20:181-186. [PMID: 38614886 DOI: 10.1016/j.reumae.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 11/22/2023] [Accepted: 12/14/2023] [Indexed: 04/15/2024]
Abstract
Temporal arteritis (TA) is the most common form of systemic vasculitis. Its diagnosis is based on criteria proposed by the American College of Rheumatology (1990), and its treatment is high-dose corticosteroids. Our objective is to assess the cost of diagnosing TA, and secondarily, cost-effective analysis of different diagnostic strategies (clinical, biopsy, doppler ultrasound) and therapeutic strategies (corticosteroid suspension). MATERIAL AND METHOD Observational, retrospective study has been carried out on patients with AT (2012-2021). Demographic data, comorbidities, signs and symptoms suggestive of AT were collected. AT was diagnosed with a score ≥ 3 according to American College of Rheumatoloy criteria (ACR-SCORE). The costs of diagnosis and treatment modification were analysed. RESULTS Seventy-five patients have been included, median age 77 (46-87) years. Headache, temporal pain and jaw claudication were significant for the diagnosis of TA. Patients with a halo on Doppler ultrasound and a positive biopsy have significantly elevated ESR and CRP compared to patients who do not. The cost of the AT diagnosis was 414.7 euros/patient. If we use ACR-SCORE ≥ 3-echodoppler it is 167.2 є/patient (savings 59.6%) and ACR-SCORE ≥ 3-biopsy 339.75 є/patient (savings 18%). If the corticosteroid was removed and a biopsy was performed, 21.6 є/patient (94.7% savings), if the corticosteroid was removed and Doppler ultrasound was performed, 10.6 є/patient (97.4% savings). CONCLUSIONS Headache, temporary pain and jaw claudication are predictors of AT. Elevated ESR and CRP are predictors of positive biopsy and presence of halo on ultrasound. The uses of ACR-SCORE ≥ 3 with Doppler ultrasound or biopsy, and with corticosteroid suspension, are cost-effective.
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Affiliation(s)
- Isabel Del Blanco Alonso
- Servicio de Angiología y Cirugía Vascular, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
| | - Álvaro Revilla Calavia
- Servicio de Angiología y Cirugía Vascular, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Laura Saiz-Viloria
- Servicio de Angiología y Cirugía Vascular, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Manuel Diez Martínez
- Servicio de Angiología y Cirugía Vascular, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Carlos Vaquero Puerta
- Servicio de Angiología y Cirugía Vascular, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Onur-Beyaz M, Demir İ, Can-Ata E. Carotid artery screening in high risk asymptomatic individuals: outcomes of 3000 carotid screening. CIR CIR 2022; 90:11-16. [PMID: 35120095 DOI: 10.24875/ciru.20001356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The primary aims of the study to evaluate the efficacy of carotid screening tests to identify asymptomatic carotid artery stenosis among high-risk patients and early prevention of stroke. BACKGROUND The estimated prevalence of asymptomatic severe carotid stenosis (≥70%) in the general adult population ranges up to 3.1%. However, the prevalence is higher in comorbid individuals. This makes it important to perform screening testing for early diagnosis and treatment in predetermined high-risk patients. MATERIAL AND METHODS In this prospective study, 3000 selected patients screened during March 2017 and September 2018 at the most populated family health center. Participants selected among registered individuals who have at least one of the risk factors such as hypertension, hyperlipidemia, diabetes mellitus, obesity, and smoking. All the participants were asymptomatic and above the age of 55. Bilateral carotid artery screening performed by Duplex Ultrasonography (DUSG) at the first call and one year later. Patients with severe carotid and/or coronary artery stenosis treated by surgical revascularization or stent implantation in the light of the latest guidelines. CONCLUSION Carotid screening among high-risk asymptomatic individuals is of great importance to identify severe carotid artery as well as coronary artery stenosis. Patient education during screening may play a crucial role in preventing the disease.
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Affiliation(s)
- Metin Onur-Beyaz
- Department of Cardiovascular Surgery, Tayfur Ata Sökmen Medical Faculty, Hatay Mustafa Kemal University, Hatay
| | - İbrahim Demir
- Department of Cardiovascular Surgery, Faculty of Medicine, Istanbul University, Istanbul
| | - Emin Can-Ata
- Department of Cardiovascular Surgery, Haseki Education and Research Hospital, Istanbul. Turkey
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Aragoncillo Sauco I, Ligero Ramos JM, Vega Martínez A, Morales Muñoz ÁL, Abad Estébanez S, Macías Carmona N, Ruiz Chiriboga D, García Pajares R, Cervera Bravo T, López-Gómez JM, Manzano Grossi S, Menéndez Sánchez E, Río Gomez J, García Prieto AM, Linares Grávalos T, Garcia Boyano F, Reparaz Asensio LM, Albalate Ramón M, de Sequera Ortiz P, Gil Casares B, Ampuero Mencía J, Castellano S, Martín Pérez B, Conty JLM, Santos Garcia A, Luño Fernandez J. Vascular access clinic results before and after implementing a multidisciplinary approach adding routine Doppler ultrasound. Nefrologia 2018; 38:616-621. [PMID: 29903522 DOI: 10.1016/j.nefro.2018.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/04/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND A multidisciplinary approach and Doppler ultrasound (DU) assessment for the creation and maintenance of arteriovenous fistulas (AVF) for haemodialysis can improve prevalence and patency. The aim of this study was to analyse the impact of a new multidisciplinary vascular access (VA) clinic with routine DU. MATERIAL AND METHODS We analysed the VA clinic results from 2014 and 2015, before and after the implementation of a multidisciplinary team protocol (vascular surgeon/nephrologist) with routine DU in preoperative mapping and prevalent AVF. RESULTS We analysed 345 and 364 patients from 2014 and 2015 respectively. The number of surgical interventions was similar in both periods (p=.289), with a trend towards an increase in preventive surgical repair of AVF in 2015 (17 vs. 29, p=.098). 155 vs. 169 new AVF were performed in 2014 and 2015, with a significantly lower primary failure rate in 2015 (26.4 vs. 15.3%, p=.015), and a non-significant increase in radiocephalic AVF, 25.8 vs. 33.2% (n=40 vs. 56), p=.159. The concordance between the indication at the clinic and the surgery performed also increased (81.3 vs. 93.5%, p=.001). Throughout 2015 fewer complementary imaging test were requested from the clinic (78 vs. 35, p <.001), with a corresponding reduction in costs (€87,716 vs. €59,445). CONCLUSIONS Multidisciplinary approach with routine DU can improve VA results, with a decrease in primary failure rate, higher likelihood of radiocephalic AVF, better management of dis-functioning AVF and lower radiological test costs.
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Affiliation(s)
| | - José Manuel Ligero Ramos
- Servicio de Cirugía Vascular periférica, Hospital Universitario Gregorio Marañón, Madrid, España
| | | | - Ángel Luis Morales Muñoz
- Servicio de Cirugía Vascular periférica, Hospital Universitario Gregorio Marañón, Madrid, España
| | | | | | - Diego Ruiz Chiriboga
- Servicio de Cirugía Vascular periférica, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Rosario García Pajares
- Servicio de Cirugía Vascular periférica, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Teresa Cervera Bravo
- Servicio de Cirugía Vascular periférica, Hospital Universitario Gregorio Marañón, Madrid, España
| | | | - Soledad Manzano Grossi
- Servicio de Cirugía Vascular periférica, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Elena Menéndez Sánchez
- Servicio de Cirugía Vascular periférica, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Javier Río Gomez
- Servicio de Cirugía Vascular periférica, Hospital Universitario Gregorio Marañón, Madrid, España
| | | | | | - Fernando Garcia Boyano
- Servicio de Cirugía Vascular periférica, Hospital Universitario Gregorio Marañón, Madrid, España
| | | | | | | | - Beatriz Gil Casares
- Servicio de Nefrología, Hospital Universitario del Sureste, Arganda del Rey, Madrid, España
| | - Jara Ampuero Mencía
- Servicio de Nefrología, Hospital Universitario del Sureste, Arganda del Rey, Madrid, España
| | | | | | - José Luís Martín Conty
- Facultad de Terapia Ocupacional, Logopedia y Enfermería de Castilla la Mancha, Talavera de la Reina, Toledo, España
| | - Alba Santos Garcia
- Servicio de Nefrología, Hospital General Universitario de Elche, Elche, Alicante, España
| | - José Luño Fernandez
- Servicio de Nefrología, Hospital Universitario Gregorio Marañón, Madrid, España
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Valero-Rosa J, Campos-Hernández JP, Carrasco-Valiente J, Gómez-Gómez E, Márquez-López FJ, Ruiz-García J, García-Rubio JH, Requena-Tapia MJ, Prieto-Castro R. Prognostic value of penile colour doppler ultrasonography for recovering erectile function after radical prostatectomy. Actas Urol Esp 2016; 40:507-12. [PMID: 27207597 DOI: 10.1016/j.acuro.2016.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/11/2016] [Accepted: 04/12/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To analyse the predictive utility of penile colour Doppler ultrasonography after the injection of vasoactive agents for recovering erectile function after radical prostatectomy. MATERIAL AND METHODS A retrospective study was conducted on patients with erectile dysfunction after radical prostatectomy who were treated with intracavernous injections of prostaglandins E1 between January 1, 2006 and December 31, 2012. The study included patients with no history of erectile dysfunction prior to the surgery and who did not respond to medical treatment. Colour Doppler was performed on all patients after the intracavernous injection. A peak systolic velocity ≥30cm/sec and an end diastolic velocity ≤5cm/sec were considered normal haemodynamic values. We assessed the result of the treatment during the follow-up using the International Index of Erectile Function-5. RESULTS We included 197 patients. The mean age was 60.8 (±6.3). The pathological diagnosis for all patients was adenocarcinoma, 74.1% of which were confined to the organ (T1-T2/Nx-N0). Treatment with injections after the surgery was started after a mean duration of 6.8 months (+3.5). The Doppler ultrasonography results were normal for 53 patients (26.9%). During the follow-up, 113 patients (57.4%) maintained functional erections; 55 of these patients (28%) did not require injections. Normal Doppler ultrasonography results were associated with a favourable response to treatment (p<.01). CONCLUSIONS The prostaglandin E1 test will help provide a diagnosis in erectile dysfunction for patients who have undergone prostatectomies. The test helps provide information on the vascular condition of the penis and useful prognostic information for the follow-up of these patients.
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Affiliation(s)
- J Valero-Rosa
- Departamento de Urología, Hospital Universitario Reina Sofía, Córdoba, España.
| | | | - J Carrasco-Valiente
- Departamento de Urología, Hospital Universitario Reina Sofía, Córdoba, España
| | - E Gómez-Gómez
- Departamento de Urología, Hospital Universitario Reina Sofía, Córdoba, España
| | - F J Márquez-López
- Departamento de Urología, Hospital Universitario Reina Sofía, Córdoba, España
| | - J Ruiz-García
- Departamento de Urología, Hospital Universitario Reina Sofía, Córdoba, España
| | - J H García-Rubio
- Departamento de Urología, Hospital Universitario Reina Sofía, Córdoba, España
| | - M J Requena-Tapia
- Departamento de Urología, Hospital Universitario Reina Sofía, Córdoba, España
| | - R Prieto-Castro
- Departamento de Urología, Hospital Universitario Reina Sofía, Córdoba, España
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