title: CT screening for comorbid disease in patients with prostatic carcinoma: is it cost-effective?
abstract: OBJECTIVE
  The role of imaging in patients with newly diagnosed prostatic carcinoma is controversial. Currently, 35% of patients with prostatic carcinoma undergo CT at the time of diagnosis, despite reports of the lack of efficacy of CT in staging the disease. We sought to evaluate the cost-effectiveness of CT in detecting unrelated comorbid disease (significant disease unrelated to prostatic carcinoma) that might affect decisions on treatment in this population of patients.
  
  
  METHODS
  We reviewed the medical records of 273 consecutive patients with newly diagnosed prostatic carcinoma who had CT of the abdomen and pelvis as part of their preoperative evaluation. Using costs based on Medicare reimbursements, we assessed the impact of the CT findings (related to comorbid disease) on overall costs and savings related to the workup and treatment of these patients.
  
  
  RESULTS
  Sixty-six patients (24%) had findings suggestive of comorbid disease. The CT findings had near-term impact on only four patients (two in whom large abdominal aortic aneurysms were detected and two in whom second primary cancers were found), despite nearly $155,000 spent on the screening CT scans and more than $4400 spent on further evaluation of false-positive CT findings. The clinical impact varied from intervening semiurgent surgery to cancellation of prostatic surgery and institution of radiation therapy.
  
  
  CONCLUSIONS
  CT is not cost-effective in screening for comorbid disease that would affect treatment in patients with newly diagnosed prostatic carcinoma.
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110.
authors.forename: H P
authors.initials: HP
authors.lastname: Forman
authors.forename: J P
authors.initials: JP
authors.lastname: Heiken
authors.forename: J A
authors.initials: JA
authors.lastname: Brink
authors.forename: H S
authors.initials: HS
authors.lastname: Glazer
authors.forename: L A
authors.initials: LA
authors.lastname: Fox
authors.forename: B L
authors.initials: BL
authors.lastname: McClennan
mesh_terms: D000368:Aged; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D006278:Medicare / Q000191:economics; D011300:Preoperative Care / Q000191:economics; D011471:Prostatic Neoplasms / Q000191:economics / Q000453:epidemiology* / Q000628:therapy; D014057:Tomography, X-Ray Computed / Q000191:economics*; D016896:Treatment Outcome; D014481:United States