Economic analysis of the use of limited coronal computed tomography scans in the management of sinusitis.
BACKGROUND
As medical costs increase, less expensive alternatives to standard diagnostic tests are sought to reduce the economic burden placed on society. One alternative is using limited, non-consecutive cut computed tomography (CT) scans for the evaluation of sinonasal disease. This study evaluates the cost-effectiveness of using limited CT scans instead of full sequence CT scans in the diagnosis and management of rhinosinusitis.


METHODS
A Medline search was performed to obtain data for the sensitivity and specificity of limited CT scans, the prevalence of abnormal CT scans, and recommendations on using limited CT scans for operative management. A standard cost-effectiveness analysis, including a sensitivity analysis, was performed using a hypothetical population of patients with sinus complaints who failed prior appropriate medical therapy.


RESULTS
At baseline, the limited CT scan was found to be less cost-effective than the full CT scan, costing $217.13 more per correct diagnosis. The sensitivity analysis demonstrated that changes in the prevalence of abnormal CT scans and the percentage of surgeons who would operate using a limited scan had the greatest impact on cost, whereas changes in the price of the full CT or limited CT scan had the least effect.


CONCLUSIONS
This study finds the use of limited CT scans to be economically unsound as a method to reduce costs in the defined population. Published literature recommends obtaining a full CT scan before operative management. Basing intervention on limited CT scans increases the possibility of erroneous diagnoses leading to either excessive or inadequate treatment of patients.
Franzese
Christine B
CB
University of Mississippi Medical Center, Department of Otolaryngology, and Communicative Sciences, Jackson, MS 39216, USA.
Stringer
Scott P
SP
D003362:Cost-Benefit Analysis; D003663:Decision Trees; D006801:Humans; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging; D012680:Sensitivity and Specificity; D012852:Sinusitis / Q000000981:diagnostic imaging* / Q000191:economics; D014057:Tomography, X-Ray Computed / Q000191:economics* / Q000379:methods