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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

Some of the tests that are recommended in the guidelines in the (A) initial and the (B) extended evaluation of syncope. While several tests of the initial evaluation were performed much less often than recommended, some more specific tests were performed more often and more early than recommended.
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EUU412F5: Some of the tests that are recommended in the guidelines in the (A) initial and the (B) extended evaluation of syncope. While several tests of the initial evaluation were performed much less often than recommended, some more specific tests were performed more often and more early than recommended.

Mentions: Since the study was entirely observational, there was nothing in the protocol or the case record forms to inform or guide the investigator about the current (2004) guidelines. However, the investigator was asked to indicate, by ticking a box, whether the implant, in his/her view, was performed ‘in an initial phase of diagnostic work-up of syncope’, i.e. early, or ‘after full evaluation of the mechanism of syncope’, i.e. late. The investigators classified 22.5% of the patients as having an early implant, whereas 67.7% had a late implant and the time-point was missing in 9.8% of the 570 patients. After the completion of the study, the early implants were compared with what the current guidelines included in the initial evaluation. We found that the proportion of patients who only had tests within the recommended initial evaluation was low, 12%, while there were many examples of over-investigation (Figure 5). The mean cost of diagnostic tests per patient in these 12% of patients was £709 compared with £1113 (95% CI £995–£1232) in the entire study population.Figure 5


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)

Some of the tests that are recommended in the guidelines in the (A) initial and the (B) extended evaluation of syncope. While several tests of the initial evaluation were performed much less often than recommended, some more specific tests were performed more often and more early than recommended.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

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

EUU412F5: Some of the tests that are recommended in the guidelines in the (A) initial and the (B) extended evaluation of syncope. While several tests of the initial evaluation were performed much less often than recommended, some more specific tests were performed more often and more early than recommended.
Mentions: Since the study was entirely observational, there was nothing in the protocol or the case record forms to inform or guide the investigator about the current (2004) guidelines. However, the investigator was asked to indicate, by ticking a box, whether the implant, in his/her view, was performed ‘in an initial phase of diagnostic work-up of syncope’, i.e. early, or ‘after full evaluation of the mechanism of syncope’, i.e. late. The investigators classified 22.5% of the patients as having an early implant, whereas 67.7% had a late implant and the time-point was missing in 9.8% of the 570 patients. After the completion of the study, the early implants were compared with what the current guidelines included in the initial evaluation. We found that the proportion of patients who only had tests within the recommended initial evaluation was low, 12%, while there were many examples of over-investigation (Figure 5). The mean cost of diagnostic tests per patient in these 12% of patients was £709 compared with £1113 (95% CI £995–£1232) in the entire study population.Figure 5

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