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Date of download: 6/1/2016 From: Cost-Effectiveness of Alternative Management Strategies for Patients with Solitary Pulmonary Nodules Ann Intern Med. 2003;138(9):724-735.

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Presentation on theme: "Date of download: 6/1/2016 From: Cost-Effectiveness of Alternative Management Strategies for Patients with Solitary Pulmonary Nodules Ann Intern Med. 2003;138(9):724-735."— Presentation transcript:

1 Date of download: 6/1/2016 From: Cost-Effectiveness of Alternative Management Strategies for Patients with Solitary Pulmonary Nodules Ann Intern Med. 2003;138(9):724-735. doi:10.7326/0003-4819-138-9-200305060-00009 Recommended sequence of diagnostic testing in patients who are at average risk for surgical complications, according to pretest probability and the results of computed tomography (CT).topbottomThe recommended sequence of tests when CT results are possibly malignant ( ) and when CT results are benign ( ) is shown. Subsequent test selection is shown to be a function of pretest probability and the corresponding post-test probability once the results of CT are known. Note that surgery is preferred when positron emission tomography (PET) results are positive, biopsy is preferred when PET results are negative, and watchful waiting is preferred when biopsy results are nondiagnostic. Recommendations are based on the assumption that society is willing to pay $100 000 per quality-adjusted life-year gained. Results were very similar when willingness to pay was assumed to be $25 000 or $50 000 per quality-adjusted life-year gained. FDG-PET = positron emission tomography with 18-fluorodeoxyglucose. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

2 Date of download: 6/1/2016 From: Cost-Effectiveness of Alternative Management Strategies for Patients with Solitary Pulmonary Nodules Ann Intern Med. 2003;138(9):724-735. doi:10.7326/0003-4819-138-9-200305060-00009 Suggested algorithm for clinical management of patients with solitary pulmonary nodules who are at average risk for surgical complications.CTThe algorithm pertains to patients with low (10% to 50%), intermediate (51% to 76%), and high (77% to 90%) pretest probability of malignancy. Note that in patients with very low pretest probability ( 90%), surgery without diagnostic testing is the preferred strategy. FDG-PET = positron emission tomography with 18-fluorodeoxyglucose. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

3 Date of download: 6/1/2016 From: Cost-Effectiveness of Alternative Management Strategies for Patients with Solitary Pulmonary Nodules Ann Intern Med. 2003;138(9):724-735. doi:10.7326/0003-4819-138-9-200305060-00009 Decision model.ACTFDG-PETBCD Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

4 Date of download: 6/1/2016 From: Cost-Effectiveness of Alternative Management Strategies for Patients with Solitary Pulmonary Nodules Ann Intern Med. 2003;138(9):724-735. doi:10.7326/0003-4819-138-9-200305060-00009 Decision model subtrees. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

5 Date of download: 6/1/2016 From: Cost-Effectiveness of Alternative Management Strategies for Patients with Solitary Pulmonary Nodules Ann Intern Med. 2003;138(9):724-735. doi:10.7326/0003-4819-138-9-200305060-00009 Markov model. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

6 Date of download: 6/1/2016 From: Cost-Effectiveness of Alternative Management Strategies for Patients with Solitary Pulmonary Nodules Ann Intern Med. 2003;138(9):724-735. doi:10.7326/0003-4819-138-9-200305060-00009 Observed and modeled survival for patients with local, regional, and distant lung cancer.SEER Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

7 Date of download: 6/1/2016 From: Cost-Effectiveness of Alternative Management Strategies for Patients with Solitary Pulmonary Nodules Ann Intern Med. 2003;138(9):724-735. doi:10.7326/0003-4819-138-9-200305060-00009 Distribution of tumor doubling times and corresponding probabilities of disease progression during the observation period.(20)black circles Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

8 Date of download: 6/1/2016 From: Cost-Effectiveness of Alternative Management Strategies for Patients with Solitary Pulmonary Nodules Ann Intern Med. 2003;138(9):724-735. doi:10.7326/0003-4819-138-9-200305060-00009 Summary receiver-operating characteristic (ROC) curve for positron emission tomography with 18-fluorodeoxyglucose (FDG-PET).dotted linesblack squareblack circle Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

9 Date of download: 6/1/2016 From: Cost-Effectiveness of Alternative Management Strategies for Patients with Solitary Pulmonary Nodules Ann Intern Med. 2003;138(9):724-735. doi:10.7326/0003-4819-138-9-200305060-00009 Summary receiver-operating characteristic (ROC) curve for computed tomography (CT).dotted lines Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

10 Date of download: 6/1/2016 From: Cost-Effectiveness of Alternative Management Strategies for Patients with Solitary Pulmonary Nodules Ann Intern Med. 2003;138(9):724-735. doi:10.7326/0003-4819-138-9-200305060-00009 Health care costs for patients with malignant pulmonary nodules.black circlesblack squaresblack triangles Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

11 Date of download: 6/1/2016 From: Cost-Effectiveness of Alternative Management Strategies for Patients with Solitary Pulmonary Nodules Ann Intern Med. 2003;138(9):724-735. doi:10.7326/0003-4819-138-9-200305060-00009 Recommended sequence of diagnostic testing in patients who are at average risk for surgical complications, according to pretest probability, computed tomography (CT) results, and threshold that determines cost- effectiveness.QALYPET Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

12 Date of download: 6/1/2016 From: Cost-Effectiveness of Alternative Management Strategies for Patients with Solitary Pulmonary Nodules Ann Intern Med. 2003;138(9):724-735. doi:10.7326/0003-4819-138-9-200305060-00009 Recommended sequence of diagnostic testing in patients who are at high risk for surgical complications, according to pretest probability, computed tomography (CT) results, and threshold that determines cost- effectiveness.FDG-PETQALY Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

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