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Costs of unstructured investigation of unexplained syncope: insights from a micro-costing analysis of the observational PICTURE registry.

Edvardsson N, Wolff C, Tsintzos S, Rieger G, Linker NJ - Europace (2015)

Bottom Line: In the 12% of patients with types of tests entirely within the recommendations for an initial evaluation before ILR implant, the mean cost was £710.Important opportunities to reduce test-related costs before an ILR implant were identified, e.g. by more appropriate use of tests recommended in the initial evaluation, by decreasing repetition of tests, and by avoiding early use of specialized and expensive tests.A structured multidisciplinary approach would be the best model to achieve an optimal outcome.

View Article: PubMed Central - PubMed

Affiliation: Sahlgrenska Academy at Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden nils.g.edvardsson@telia.com.

No MeSH data available.


Related in: MedlinePlus

The pyramide plots demonstrate that tests were often repeated and show how often they were prescribed early (to the left of the middle line) and late (to the right of the middle line) evaluation as judged by the investigators. (A) Exercise test; (B) neurological and/or psychiatric evaluation; (C) electroencephalography; and (D) MRI or CT scan.
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EUU412F4: The pyramide plots demonstrate that tests were often repeated and show how often they were prescribed early (to the left of the middle line) and late (to the right of the middle line) evaluation as judged by the investigators. (A) Exercise test; (B) neurological and/or psychiatric evaluation; (C) electroencephalography; and (D) MRI or CT scan.

Mentions: Neurological investigations were common, which may be explained by the fact that a neurologist or a psychiatrist was frequently consulted as the first specialist. Eleven per cent of patients were referred to a neurologist as their first specialist, and in total 47% had seen a neurologist before the ILR implant. Probably as a consequence, neurological tests, such as EEG (39%) and MRI/CT (47%), were commonly prescribed, also in what the investigators described as early in the investigation. In the current guidelines, such investigations are only recommended when non-syncopal transient loss of consciousness (T-LOC) is suspected, most importantly when epilepsy is a likely or possible reason. Similarly, the number of patients undergoing more than one EEG and/or MRI/CT was high (Figure 4).Figure 4


Costs of unstructured investigation of unexplained syncope: insights from a micro-costing analysis of the observational PICTURE registry.

Edvardsson N, Wolff C, Tsintzos S, Rieger G, Linker NJ - Europace (2015)

The pyramide plots demonstrate that tests were often repeated and show how often they were prescribed early (to the left of the middle line) and late (to the right of the middle line) evaluation as judged by the investigators. (A) Exercise test; (B) neurological and/or psychiatric evaluation; (C) electroencephalography; and (D) MRI or CT scan.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4482287&req=5

EUU412F4: The pyramide plots demonstrate that tests were often repeated and show how often they were prescribed early (to the left of the middle line) and late (to the right of the middle line) evaluation as judged by the investigators. (A) Exercise test; (B) neurological and/or psychiatric evaluation; (C) electroencephalography; and (D) MRI or CT scan.
Mentions: Neurological investigations were common, which may be explained by the fact that a neurologist or a psychiatrist was frequently consulted as the first specialist. Eleven per cent of patients were referred to a neurologist as their first specialist, and in total 47% had seen a neurologist before the ILR implant. Probably as a consequence, neurological tests, such as EEG (39%) and MRI/CT (47%), were commonly prescribed, also in what the investigators described as early in the investigation. In the current guidelines, such investigations are only recommended when non-syncopal transient loss of consciousness (T-LOC) is suspected, most importantly when epilepsy is a likely or possible reason. Similarly, the number of patients undergoing more than one EEG and/or MRI/CT was high (Figure 4).Figure 4

Bottom Line: In the 12% of patients with types of tests entirely within the recommendations for an initial evaluation before ILR implant, the mean cost was £710.Important opportunities to reduce test-related costs before an ILR implant were identified, e.g. by more appropriate use of tests recommended in the initial evaluation, by decreasing repetition of tests, and by avoiding early use of specialized and expensive tests.A structured multidisciplinary approach would be the best model to achieve an optimal outcome.

View Article: PubMed Central - PubMed

Affiliation: Sahlgrenska Academy at Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden nils.g.edvardsson@telia.com.

No MeSH data available.


Related in: MedlinePlus