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COMPARISON OF DIRECT AND INDIRECT COSTS OF MAGNETIC RESONANCE AND COMPUTED TOMOGRAPHY IN THE EVALUATION OF INCIDENTAL ADRENAL MASSES

Yıl 2023, Cilt: 25 Sayı: 1, 115 - 121, 30.04.2023
https://doi.org/10.24938/kutfd.1216853

Öz

Objective: It was planned to compare the direct and indirect costs of computed tomography (CT) and magnetic resonance (MR) methods in the differentiation of adrenal adenoma and non adenoma.

Material and Methods: CT, MR, pathology, laboratory and other information of the patients were obtained from the patient files. Radiological examination and unilateral laparoscopic adrenalectomy cost information was obtained from the accounting department. For cost calculation; the scenario was used in which 500 patients were referred equally to CT and MR, individuals diagnosed with non-adenoma were referred to the operation after the first control, individuals diagnosed with adenoma were followed, and standard follow-up was done every 6 months for 4 years.

Results: A total of 31 patients (8 males and 23 females) were eligible for the study. The mean age of the patients was 48.1+17.7 years. In the CT group, an excess cost of 609,0 ₺ per person for 1 year and 2435,9 ₺ per person for 4 years was incurred. In the diagnosis of adenoma and non-adenoma, CT was inaccurate in 24.4% of patients, whereas MR was inaccurate in 5.2%. When used for the diagnosis of pheochromocytoma, it was found that in the CT group, 609,0 ₺ per person for 1 year and 2435,9 ₺ per person for 4 years resulted in an excess cost, whereas CT was erroneous in 17.6% of patients and MR in 15.8% of patients. In the diagnosis of malignancy, in the CT group, an excess cost of 522,2 ₺ per person for 1 year and 2088,7 ₺ per person for 4 years was incurred. It was determined that correct decision could not be made in 33.2% of the patients in the CT group and in 5.8% of the patients in the MR group.

Conclusion: The use of contrast-enhanced MR in patients of adrenal masses reduces unnecessary interventions and the resulting expenditures.

Kaynakça

  • Herrera MF, Grant CS, van Heerden JA, Sheedy PF, Ilstrup DM. Incidentally discovered adrenal tumors: an institutional perspective. Surgery. 1991;110(6):1014–21
  • Herra MF, Pantoja JP, Espagna N. Adrenal incidentalomas. In: Linos D, van Heerden JA, eds. Adrenal glands: diagnostic aspects and surgical therapy. Berlin: Springer-Verlag. 2005;231–44
  • Young Jr WF. Management approaches to adrenal incidentalomas. A view from Rochester, Minnesota. Endocrinol Metab Clin North Am. 2000;29(1):159–85
  • Nieman LK. Approach to the patient with an adrenal incidentaloma. J Clin Endocrinol Metab. 2010 Sep;95(9):4106-13.
  • Ghanem N, Altehoefer C, Thürl C, Bley T, Langer M. Computertomographie und Magnetresonanztomo-graphie in der Differentialdiagnose von Nebennierenraumforderungen [CT and MRI in the differential diagnosis of lesions of the adrenal gland]. Med Klin (Munich). 2004;99(8):447-52.
  • van Erkel AR, van Gils AP, Lequin M, Kruitwagen C, Bloem JL, Falke TH. CT and MR distinction of adenomas and nonadenomas of the adrenal gland. J Comput Assist Tomogr. 1994;18(3):432-8.
  • Schieda N, Alrashed A, Flood TA, Samji K, Shabana W, McInnes MD. Comparison of Quantitative MRI and CT Washout Analysis for Differentiation of Adrenal Pheochromocytoma From Adrenal Adenoma. AJR Am J Roentgenol. 2016;206(6):1141-8
  • Kievit J, Haak HR, Dıagnosıs And Treatment Of Adrenal Incıdentaloma: A Cost-Effectiveness Analysis. Endocrinology and Metabolism Clinics of North America. 2000;29(1);69-90
  • Wang X, Li K, Sun H, Zhao J, Zheng L, Zhang Z, Bai R, Zhang G. Differentiation between adrenal adenomas and nonadenomas using dynamic contrast-enhanced computed tomography. Onco Targets Ther. 2016;9:6809-17.
  • Lee M, Hahn P, Papanicolaou N, et al. Benign and malignant adrenal masses: CT distinction with attenuation coefficients, size and observer analysis. Radiology. 1991;179(2):415-8.
  • Singer AA, Obuchowski NA, Einstein DM, Paushter DM. Metastasis or adenoma? Computed tomographic evaluation of the adrenal mass. Cleveland Clin J Med. I994;61(3):200-5.
  • Korobkin, M., Brodeur, F. J., Yutzy, G. G., Francis, I. R., Quint, L. E., Dunnick, N. R., et al. Differentiation of Adrenal Adenomas from Nonadenomas using CT Attenuation values. Am J Roenigenol. 1996:166(3):531-6.
  • Inan N, Arslan A, Akansel G, Anik Y, Balci NC, Demirci A. Dynamic contrast enhanced MRI in the differential diagnosis of adrenal adenomas and malignant adrenal masses. Eur J Radiol. 2008;65(1):154-62
  • Dwamena BA, Kloos RT, Fendrick AM, Gross MD, Francis IR, Korobkin MT, et al. Diagnostic evaluation of the adrenal incidentaloma: decision and cost-effectiveness analyses. J Nucl Med. 1998;39(4):707-12.
  • Lumachi F, Basso SM, Borsato S, Tregnaghi A, Zucchetta P, Marzola MC, et al. Role and cost-effectiveness of adrenal imaging and image-guided FNA cytology in the management of incidentally discovered adrenal tumours. Anticancer Res. 2005;25(6C):4559-62.

İnsidental Adrenal Kitlelerin Değerlendirilmesinde Manyetik Rezonans ve Bilgisayarlı Tomografinin Direkt ve Dolaylı Maliyetlerinin Karşılaştırılması

Yıl 2023, Cilt: 25 Sayı: 1, 115 - 121, 30.04.2023
https://doi.org/10.24938/kutfd.1216853

Öz

Amaç: Bilgisayarlı tomografi (BT) ve manyetik rezonans (MR) yöntemlerinin adrenal adenom ve non adenom ayrımında direkt ve dolaylı maliyetlerininin karşılaştırılması planlanmıştır.

Gereç ve Yöntemler: Hastaların BT, MR, patoloji, laboratuvar ve diğer bilgileri hasta dosyalarından elde edildi. Sosyal Güvenlik Kurumu’nun kontrastlı BT için 170 Türk Lirası (₺), kontrastlı MR için 202 ₺, tek taraflı laparoskopik sürrenalektomi için 18036 ₺ ödeme yaptığı fatura bölümünden öğrenildi. Maliyet hesaplaması için, 500 hastanın eşit olarak BT’ye ve MR’a yönlendirildiği, non adenom tanısı alanların ilk kontrol sonrası operasyona yönlendirildiği, adenom tanısı alanların ise takip edildiği; standart takibin 4 yıl boyunca 6 ayda bir yapıldığı senaryosu kullanıldı.

Bulgular: Çalışmaya uygun olan 8 erkek ve 23 kadın olmak üzere 31 hasta tespit edildi. Hastaların yaş ortalaması 48.1+17.7 idi. BT kolunda 1 yıl için kişi başı 609,0 ₺ fazla, 4 yıl için kişi başı 2435,9 ₺ maliyet oluşmaktadır. Adenom ve non adenom tanısında BT'nin hastaların %24.4'ünde, MR'ın ise hastaların %5.2'sinde hatalı karar verdiği görüldü. Feokromasitoma tanısı için kullanıldığında BT’nin 1 yıl için kişi başı 609,0 ₺; 4 yıl için kişi başı 2435,9 ₺ fazla maliyet oluşturduğu, buna karşın BT'nin hastaların %17.6'sında, MR'ın ise hastaların %15.8'inde hatalı karar verdiği tespit edildi. Malignite tanısında BT kolunda 1 yıl için kişi başı 52,2 ₺, 4 yıl için kişi başı 2088,7 ₺ fazla maliyet oluşmaktadır. BT grubunda hastaların %33.2'sinde, buna karşılık MR grubunda %5.8'inde doğru karar verilemediği saptandı.

Sonuç: Endokrinoloji polikliniğine yönlendirilen adrenal kitlelerin değerlendirilmesinde kontastlı MR kullanılması gereksiz müdahaleleri ve bundan kaynaklı harcamaları azaltmaktadır.

Kaynakça

  • Herrera MF, Grant CS, van Heerden JA, Sheedy PF, Ilstrup DM. Incidentally discovered adrenal tumors: an institutional perspective. Surgery. 1991;110(6):1014–21
  • Herra MF, Pantoja JP, Espagna N. Adrenal incidentalomas. In: Linos D, van Heerden JA, eds. Adrenal glands: diagnostic aspects and surgical therapy. Berlin: Springer-Verlag. 2005;231–44
  • Young Jr WF. Management approaches to adrenal incidentalomas. A view from Rochester, Minnesota. Endocrinol Metab Clin North Am. 2000;29(1):159–85
  • Nieman LK. Approach to the patient with an adrenal incidentaloma. J Clin Endocrinol Metab. 2010 Sep;95(9):4106-13.
  • Ghanem N, Altehoefer C, Thürl C, Bley T, Langer M. Computertomographie und Magnetresonanztomo-graphie in der Differentialdiagnose von Nebennierenraumforderungen [CT and MRI in the differential diagnosis of lesions of the adrenal gland]. Med Klin (Munich). 2004;99(8):447-52.
  • van Erkel AR, van Gils AP, Lequin M, Kruitwagen C, Bloem JL, Falke TH. CT and MR distinction of adenomas and nonadenomas of the adrenal gland. J Comput Assist Tomogr. 1994;18(3):432-8.
  • Schieda N, Alrashed A, Flood TA, Samji K, Shabana W, McInnes MD. Comparison of Quantitative MRI and CT Washout Analysis for Differentiation of Adrenal Pheochromocytoma From Adrenal Adenoma. AJR Am J Roentgenol. 2016;206(6):1141-8
  • Kievit J, Haak HR, Dıagnosıs And Treatment Of Adrenal Incıdentaloma: A Cost-Effectiveness Analysis. Endocrinology and Metabolism Clinics of North America. 2000;29(1);69-90
  • Wang X, Li K, Sun H, Zhao J, Zheng L, Zhang Z, Bai R, Zhang G. Differentiation between adrenal adenomas and nonadenomas using dynamic contrast-enhanced computed tomography. Onco Targets Ther. 2016;9:6809-17.
  • Lee M, Hahn P, Papanicolaou N, et al. Benign and malignant adrenal masses: CT distinction with attenuation coefficients, size and observer analysis. Radiology. 1991;179(2):415-8.
  • Singer AA, Obuchowski NA, Einstein DM, Paushter DM. Metastasis or adenoma? Computed tomographic evaluation of the adrenal mass. Cleveland Clin J Med. I994;61(3):200-5.
  • Korobkin, M., Brodeur, F. J., Yutzy, G. G., Francis, I. R., Quint, L. E., Dunnick, N. R., et al. Differentiation of Adrenal Adenomas from Nonadenomas using CT Attenuation values. Am J Roenigenol. 1996:166(3):531-6.
  • Inan N, Arslan A, Akansel G, Anik Y, Balci NC, Demirci A. Dynamic contrast enhanced MRI in the differential diagnosis of adrenal adenomas and malignant adrenal masses. Eur J Radiol. 2008;65(1):154-62
  • Dwamena BA, Kloos RT, Fendrick AM, Gross MD, Francis IR, Korobkin MT, et al. Diagnostic evaluation of the adrenal incidentaloma: decision and cost-effectiveness analyses. J Nucl Med. 1998;39(4):707-12.
  • Lumachi F, Basso SM, Borsato S, Tregnaghi A, Zucchetta P, Marzola MC, et al. Role and cost-effectiveness of adrenal imaging and image-guided FNA cytology in the management of incidentally discovered adrenal tumours. Anticancer Res. 2005;25(6C):4559-62.
Toplam 15 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Özgün Araştırma
Yazarlar

Mutlu Güneş 0000-0001-9756-2285

Erken Görünüm Tarihi 30 Nisan 2023
Yayımlanma Tarihi 30 Nisan 2023
Gönderilme Tarihi 9 Aralık 2022
Yayımlandığı Sayı Yıl 2023 Cilt: 25 Sayı: 1

Kaynak Göster

APA Güneş, M. (2023). COMPARISON OF DIRECT AND INDIRECT COSTS OF MAGNETIC RESONANCE AND COMPUTED TOMOGRAPHY IN THE EVALUATION OF INCIDENTAL ADRENAL MASSES. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, 25(1), 115-121. https://doi.org/10.24938/kutfd.1216853
AMA Güneş M. COMPARISON OF DIRECT AND INDIRECT COSTS OF MAGNETIC RESONANCE AND COMPUTED TOMOGRAPHY IN THE EVALUATION OF INCIDENTAL ADRENAL MASSES. Kırıkkale Üni Tıp Derg. Nisan 2023;25(1):115-121. doi:10.24938/kutfd.1216853
Chicago Güneş, Mutlu. “COMPARISON OF DIRECT AND INDIRECT COSTS OF MAGNETIC RESONANCE AND COMPUTED TOMOGRAPHY IN THE EVALUATION OF INCIDENTAL ADRENAL MASSES”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 25, sy. 1 (Nisan 2023): 115-21. https://doi.org/10.24938/kutfd.1216853.
EndNote Güneş M (01 Nisan 2023) COMPARISON OF DIRECT AND INDIRECT COSTS OF MAGNETIC RESONANCE AND COMPUTED TOMOGRAPHY IN THE EVALUATION OF INCIDENTAL ADRENAL MASSES. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 25 1 115–121.
IEEE M. Güneş, “COMPARISON OF DIRECT AND INDIRECT COSTS OF MAGNETIC RESONANCE AND COMPUTED TOMOGRAPHY IN THE EVALUATION OF INCIDENTAL ADRENAL MASSES”, Kırıkkale Üni Tıp Derg, c. 25, sy. 1, ss. 115–121, 2023, doi: 10.24938/kutfd.1216853.
ISNAD Güneş, Mutlu. “COMPARISON OF DIRECT AND INDIRECT COSTS OF MAGNETIC RESONANCE AND COMPUTED TOMOGRAPHY IN THE EVALUATION OF INCIDENTAL ADRENAL MASSES”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 25/1 (Nisan 2023), 115-121. https://doi.org/10.24938/kutfd.1216853.
JAMA Güneş M. COMPARISON OF DIRECT AND INDIRECT COSTS OF MAGNETIC RESONANCE AND COMPUTED TOMOGRAPHY IN THE EVALUATION OF INCIDENTAL ADRENAL MASSES. Kırıkkale Üni Tıp Derg. 2023;25:115–121.
MLA Güneş, Mutlu. “COMPARISON OF DIRECT AND INDIRECT COSTS OF MAGNETIC RESONANCE AND COMPUTED TOMOGRAPHY IN THE EVALUATION OF INCIDENTAL ADRENAL MASSES”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, c. 25, sy. 1, 2023, ss. 115-21, doi:10.24938/kutfd.1216853.
Vancouver Güneş M. COMPARISON OF DIRECT AND INDIRECT COSTS OF MAGNETIC RESONANCE AND COMPUTED TOMOGRAPHY IN THE EVALUATION OF INCIDENTAL ADRENAL MASSES. Kırıkkale Üni Tıp Derg. 2023;25(1):115-21.

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