David J. Vanness

Unsuspected extracolonic findings at screening CT colonography: clinical and economic impact.

PURPOSE To evaluate the frequency and estimated costs of additional diagnostic workup for extracolonic findings detected at computed tomographic (CT) colonography in a large screening cohort. MATERIALS AND METHODS This retrospective HIPAA-compliant study, which had institutional review board approval, evaluated extracolonic findings in 2195 consecutive asymptomatic adults (1199 women, 996 men; age range, 40-90 years; mean age, 58.0 years +/- 8.1 [standard deviation]) undergoing low-dose CT colonographic screening performed without contrast material at a single institution over a 20-month period. All diagnostic workups generated because of extracolonic findings were reviewed. Associated costs were estimated by using 2006 Medicare average reimbursement. Testing for statistical significance was performed by using the chi(2) and t tests. RESULTS Further diagnostic workup for unsuspected extracolonic findings was performed in 133 (6.1%) of 2195 patients, including 18 patients in whom additional workup was not recommended by the radiologist. Additional testing included ultrasonography (n = 64), CT (n = 59), magnetic resonance imaging (n = 11), other diagnostic imaging tests (n = 19), nonsurgical invasive procedures (n = 19), and surgical procedures (n = 22). Benign findings were confirmed in the majority of cases, but relevant new diagnoses were made in 55 (2.5%) patients, including extracolonic malignancies in nine patients. The mean cost per patient for nonsurgical procedures was

Cost-Effectiveness Analysis of Linezolid, Daptomycin, and Vancomycin in Methicillin-Resistant Staphylococcus aureus: Complicated Skin and Skin Structure Infection Using Bayesian Methods for Evidence Synthesis

31.02 (95% confidence interval:

Predicting persistently high primary care use.

23.72,

Comparative Economic Evaluation of Data from the ACRIN National CT Colonography Trial with Three Cancer Intervention and Surveillance Modeling Network Microsimulations

38.94); that for surgical procedures was

Systematic review and mixed treatment comparison meta-analysis of randomized clinical trials of primary oral antifungal prophylaxis in allogeneic hematopoietic cell transplant recipients

67.54 (95% confidence interval:

Quantifying the Accuracy of Forensic Examiners in the Absence of a “Gold Standard”

38.62,

Estimating the Opportunity Costs of Osteoporosis in the United States

101.55). CONCLUSION Detection of relevant unsuspected extracolonic disease at CT colonographic screening is not rare, accounting for a relatively large percentage of cases in which additional workup was recommended. Judicious handling of potential extracolonic findings is warranted to balance the cost of additional workup against the potential for early detection of important disease, because many findings will prove to be of no clinical consequence.

Do Bayesian adaptive trials offer advantages for comparative effectiveness research? Protocol for the RE-ADAPT study

BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) complicated skin and skin structure infection (cSSSI) is a prominent infection encountered in hospital and outpatient settings that is associated with high resource use for the health-care system. OBJECTIVE A decision analytic (DA) model was developed to evaluate the cost-effectiveness analysis (CEA) of linezolid, daptomycin, and vancomycin in MRSA cSSSI. METHODS Bayesian methods for evidence synthesis were used to generate efficacy and safety parameters for a DA model using published clinical trials. CEA was done from the US health-care perspective. Efficacy was defined as a successfully treated patient at the test of cure without any adverse reaction. Primary outcome was the incremental cost-effectiveness ratio between linezolid and vancomycin, daptomycin and vancomycin, and linezolid and daptomycin in MRSA cSSSI. Univariate and probabilistic sensitivity analyses were performed to test the robustness of the model. RESULTS The total direct costs of linezolid, daptomycin, and vancomycin were

Impact of estradiol-valerate/dienogest on work productivity and activities of daily living in European and Australian women with heavy menstrual bleeding.

18,057,

Some Cautions on the Use of Instrumental Variables Estimators in Outcomes Research: How Bias in Instrumental Variables Estimators Is Affected by Instrument Strength, Instrument Contamination, and Sample Size

20,698, and