title: Cost-effectiveness of CT thorax and bronchoscopy in haemoptysis with normal CXR for exclusion of lung cancer.
abstract: As fibre-optic bronchoscopy and CT thorax become more widely used, patients with haemoptysis who had normal CXR and sputum results are more commonly offered both CT and bronchoscopy to exclude lung cancer. Doctors who are under possible litigation pressure arising from missed diagnoses of lung cancer are often exhaustive in their investigations, even when the haemoptysis has been transient. The present study aims to investigate the number of cancer patients who can be detected with the two investigations, and compare recent similar study results with archive results. We found that despite the use of more efficient investigation tools, the yield is paradoxically much lower and, hence, less cost-effective than that of previous studies. The likely reason is that doctors tend to over-investigate, even for short-term, minimal blood-streaked sputum, which is common among simple bronchitis. In order to be more cost-effective, these investigations should be used more selectively and for high risk patients such as those with prolonged haemoptysis and those who are heavy smokers.
authors.affiliation: TB and Chest Unit, Wong Tai Sin Hospital, Hong Kong. lawg@hotmail.com
authors.forename: G T S
authors.initials: GT
authors.lastname: Law
authors.forename: C Y
authors.initials: CY
authors.lastname: Wong
authors.forename: Y C
authors.initials: YC
authors.lastname: Chan
authors.forename: T T
authors.initials: TT
authors.lastname: Shum
authors.forename: P S
authors.initials: PS
authors.lastname: Lok
authors.forename: K Y
authors.initials: KY
authors.lastname: Wong
mesh_terms: D001999:Bronchoscopy / Q000191:economics*; D003362:Cost-Benefit Analysis; D006469:Hemoptysis / Q000191:economics / Q000209:etiology*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000191:economics*; D013902:Radiography, Thoracic / Q000191:economics; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000191:economics*