title: Chest Computed Tomographic Image Screening for Cystic Lung Diseases in Patients with Spontaneous Pneumothorax Is Cost Effective.
abstract: BACKGROUND
  Patients without a known history of lung disease presenting with a spontaneous pneumothorax are generally diagnosed as having primary spontaneous pneumothorax. However, occult diffuse cystic lung diseases such as Birt-Hogg-Dubé syndrome (BHD), lymphangioleiomyomatosis (LAM), and pulmonary Langerhans cell histiocytosis (PLCH) can also first present with a spontaneous pneumothorax, and their early identification by high-resolution computed tomographic (HRCT) chest imaging has implications for subsequent management.
  
  
  OBJECTIVE
  The objective of our study was to evaluate the cost-effectiveness of HRCT chest imaging to facilitate early diagnosis of LAM, BHD, and PLCH.
  
  
  METHODS
  We constructed a Markov state-transition model to assess the cost-effectiveness of screening HRCT to facilitate early diagnosis of diffuse cystic lung diseases in patients presenting with an apparent primary spontaneous pneumothorax. Baseline data for prevalence of BHD, LAM, and PLCH and rates of recurrent pneumothoraces in each of these diseases were derived from the literature. Costs were extracted from 2014 Medicare data. We compared a strategy of HRCT screening followed by pleurodesis in patients with LAM, BHD, or PLCH versus conventional management with no HRCT screening.
  
  
  RESULTS
  In our base case analysis, screening for the presence of BHD, LAM, or PLCH in patients presenting with a spontaneous pneumothorax was cost effective, with a marginal cost-effectiveness ratio of $1,427 per quality-adjusted life-year gained. Sensitivity analysis showed that screening HRCT remained cost effective for diffuse cystic lung diseases prevalence as low as 0.01%.
  
  
  CONCLUSIONS
  HRCT image screening for BHD, LAM, and PLCH in patients with apparent primary spontaneous pneumothorax is cost effective. Clinicians should consider performing a screening HRCT in patients presenting with apparent primary spontaneous pneumothorax.
authors.affiliation: 1 Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine.
authors.forename: Nishant
authors.identifier: http://orcid.org/0000-0001-9112-1315
authors.initials: N
authors.lastname: Gupta
authors.affiliation: 2 Department of Environmental Heath, and.
authors.forename: Dale
authors.initials: D
authors.lastname: Langenderfer
authors.affiliation: 1 Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine.
authors.forename: Francis X
authors.initials: FX
authors.lastname: McCormack
authors.affiliation: 3 Division of General Internal Medicine, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Schauer
authors.affiliation: 3 Division of General Internal Medicine, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Eckman
mesh_terms: D000328:Adult; D058249:Birt-Hogg-Dube Syndrome / Q000150:complications / Q000000981:diagnostic imaging*; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D042241:Early Diagnosis; D005260:Female; D006646:Histiocytosis, Langerhans-Cell / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D008171:Lung Diseases / Q000150:complications / Q000000981:diagnostic imaging; D018192:Lymphangioleiomyomatosis / Q000150:complications / Q000000981:diagnostic imaging*; D008390:Markov Chains; D006278:Medicare; D018700:Pleurodesis; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000379:methods*; D014481:United States
keywords: Birt-Hogg-Dubé syndrome; lymphangioleiomyomatosis; pneumothorax; pulmonary Langerhans cell histiocytosis