Anna Micaela Ciarrapico

Cost-effectiveness analysis of two vacuum-assisted breast biopsy systems: Mammotome and Vacora

PurposeThis study was undertaken to compare the cost effectiveness of two vacuum-assisted breast biopsy devices, the Mammotome and Vacora systems.Materials and methodsBetween January and June 2006, 238 vacuum-assisted breast biopsies were performed at our radiology department. Five out of 238 lesions were excluded because of inadequate sampling. The Mammotome system was used in 108/233 lesions and the Vacora system in 125/233. Fifty-eight lesions underwent ultrasound-guided breast biopsy, and 50 lesions underwent mammography-guided biopsy with both Mammotome and Vacora devices. Magnetic-resonance-guided biopsy was possible with the Vacora system only (17/125 lesions).ResultsAll procedures were successfully completed. No significant differences were found between the results of the Mammotome and Vacora biopsies in terms of effectiveness: sensitivity was 84.4% and 86.2%, respectively, and specificity 100%. In terms of cost, the Mammotome system has higher costs per procedure compared with the Vacora.ConclusionsOur clinical results confirm the diagnostic accuracy of both the Mammotome and Vacora systems, whereas our cost analysis shows that there is a considerable difference, mostly related to the initial investment.RiassuntoScopoConfrontare costi ed efficacia di due sistemi di biopsia mammaria ad aspirazione forzata: Mammotome e Vacora.Materiali e metodiPresso il nostro Centro, dal gennaio a giugno 2006 sono state sottoposte a caratterizzazione istologica mediante prelievo VAB 238 lesioni mammarie. Di queste 5/238 sono state escluse dalla nostra casistica per numero insufficiente di frustoli prelevati. In 108/233 lesioni è stato utilizzato il sistema Mammotome ed in 125/233 il Vacora. Con entrambi i sistemi sono state sottoposte a prelievo 58 lesioni sotto guida ecografica e 50 sotto guida mammografica. Per la guida RM è stato utilizzato unicamente il sistema Vacora (17/125 lesioni).RisultatiTutte le procedure considerate sono state portate a termine con successo. L’efficacia diagnostica dei due sistemi è risultata sovrapponibile: sensibilità 84,4%–86,2%, specificità 100%. I costi unitari delle singole procedure risultano maggiori per il sistema Mammotome, rispetto al Vacora.ConclusioniI risultati clinici confermano l’accuratezza diagnostica di entrambi i sistemi mentre, ai fini della valutazione economica delle procedure, il fattore determinante è l’investimento iniziale.

European banks and cross-selling

According to a part of economic literature, the growing competition among financial intermediaries, together with the consequent interest margin shrink, induced many banks to enter new markets and adopt cross-selling strategies. Our results show that two kinds of banks coexist in Europe: cross-selling banks, more interested in ‘depositors’ than in loans, and traditional banks, interested in granting loans to good borrowers. The awareness of the deep difference existing between these two types of banks now operating in Europe is very important for the implementation of an effective economic policy in the face of the financial crisis. We find evidence that cross-selling banks tend to be localized in countries where the banking system is less concentrated but they are not characterized by lower interest margins.

Inappropriateness of breast imaging: cost analysis

PurposeThe aim of this study was to assess how an incorrect indication for an examination may affect the diagnostic workup and diagnosis as well as healthcare expenditure.Materials and methodsWe considered all the requests for breast imaging (mammography, ultrasound and magnetic resonance imaging) received by our radiology department between October 2010 and December 2010, and assessed their appropriateness based on the patient’s age and the clinical question, if present. We then analysed the unnecessary costs resulting from inappropriate requests.ResultsOut of a total of 1500 requests for ultrasound examination, the request was appropriate in 855 (57%) cases; out of a total of 2350 requests for mammography, the request was appropriate in 493 (21%) cases; out of a total of 100 requests for magnetic resonance imaging, the request was appropriate in 83 (83%) cases. The cost deriving from inappropriate requests was 51,235.04 Euros.ConclusionsImproving the timeliness of diagnosis is an important goal to be pursued by enhancing the available health services, improving communication and coordination of the different professionals involved and optimising diagnostic pathways in order to reduce healthcare spending.RiassuntoObiettivoScopo del presente lavoro è stato valutare come, nella diagnostica senologica, una non corretta indicazione ad un esame possa influire sul percorso diagnostico, sulla diagnosi e sulla spesa sanitaria che ne deriva.Materiali e metodiAbbiamo preso in considerazione tutte le richieste di esami di diagnostica senologica [mammografia, ecografia e risonanza magnetica (RM)], giunte presso il Dipartimento di Diagnostica per Immagini dello IRCS, Policlinico Universitario di Tor Vergata, Roma, nel periodo compreso tra ottobre 2010 e dicembre 2010, valutandone la loro appropriatezza in base all’età delle pazienti ed al quesito clinico, quando presente: abbiamo quindi analizzato i costi inutili che ne sono derivati.RisultatiPer quanto concerne l’ecografia mammaria, abbiamo riscontrato che, su un totale di 1500 esami richiesti, in 855 casi (57%) la richiesta risultava inappropriata; delle 2350 richieste di mammografie il 21% (493 esami) è risultato inappropriato ed infine per gli esami di RM, delle 100 richieste ricevute, l’83% risultavano inappropriate. La spesa globale relativa all’inappropriatezza delle richieste prese in esame è stata di 51235,04 Euro.ConclusioniIl miglioramento della tempestività della diagnosi è un obiettivo rilevante da perseguire attraverso un potenziamento dei servizi sanitari a disposizione, tale da migliorare la comunicazione ed il coordinamento tra le diverse figure professionali specialistiche interessate, al fine di ottimizzare i percorsi diagnostici con conseguente diminuzione della spesa sanitaria.

Secondary prevention at 360°: the important role of diagnostic imaging

The aim of this paper is to underline the importance of the role of general practitioners (GPs) in distributing vital information about prevention to citizens, to highlight the importance of the so-called voluntary prevention programmes, both for conditions for which no organised screening programmes exist and for those for which they do exist but may well be obsolete or inefficient. Nowadays, voluntary prevention is made more effective thanks to the new sophisticated diagnostic technologies applied worldwide by diagnostic imaging. Epidemiological data about the incidence and causes of death among the Italian population have shown that screening programmes should be aimed first at fighting the following diseases: prostatic carcinoma, lung cancer, colorectal carcinoma, breast cancer, cardiovascular disease, cerebrovascular disease, aortic and peripheral vascular disease. GPs do not generally give good or adequate instructions concerning voluntary prevention programmes; GPs may not even be aware of this type of prevention which could represent a valuable option together with the existing mass screening programmes. Therefore, in the following analysis, we aim to outline the correct diagnostic pathway for the prevention of diseases having the highest incidence in our country and which represent the most frequent causes of death. If used correctly, these screening programmes may contribute to the success of secondary prevention, limiting the use of tertiary prevention and thus producing savings for the Italian National Health System.