Costo-efectividad de la tomografía computarizada y la ecografía en el diagnóstico de apendicitis / Cost-effectiveness of computed tomography and ultrasound in the diagnosis of appendicitis

Introduction. Diagnosis of acute appendicitis is difficult in nearly 30 percent of patients with pain inlow right quadrant. Diagnostic imaging may provide a means of a more accurate diagnosis. Objective. The cost-effectiveness of diagnostic image tests was calculated for comparison with routine physical examination in patients with abdominal pain suspected to be appendicitis. Materials and methods. A cost-effectiveness protocol was designed, using a decision analysis model. The standard case was a patient with abdominal pain in right lower quadrant and suspicion of appendicitis. Three independent diagnostic alternatives were selected— ultrasonography, abdominal tomography and physical exam in hospital with the subject under observation less than six hours. Operative characteristics, study design and costs of interventions and outcomes were assessed. The main outcome consisted of a confirmed diagnosis of appendicitis. The point of view taken was that of health maintenance organizations. Direct and indirect medical costs were measured. Time horizon used was three months. A one way sensitivity analysis was made. Results. For a prepaid system, the most cost-effective strategy was abdominal tomography, with a cost-effectiveness ratio of US$965/diagnosed patient. For public system, the most cost-effective strategy was abdominal tomography, with a cost-effectiveness ratio of US$492/ diagnosed patient. Conclusions. Imaging diagnostic methods, in cases of abdominal pain suspected to be appendicitis, are more cost-effective than physical exam to make accurate diagnostic decisions. Tomography offers the best cost-effectiveness in prepaid system and in public health system.

Recomendaciones actuales para el tamizaje del cáncer de seno de acuerdo a la evidencia médica / Current recommendation for breast screeening according to evidence

La mamografia en el tamizaje del cancer de seno se ha utilizado buscando reducir la mortalidad atribuída a esta enfermedad. Sin embargo continuas áreas de controversia en cuanto a su real impacto en la mortalidad, edad de inicio, intervalo entre mamografías han sido publicados. El análisis completo de esta información es tema ineludible para el cuerpo médico, en especial para aquellos involucrados en la atención directa de la poblacion femenina. Esta revisión pretende resumir las principales recomendaciones del uso de la mamografía en el tamizaje de seno de acuerdo a la evidencia médica. se revisan ademas los beneficios directos e indirectos del tamizaje mamográfico, asi como sus potenciales riesgos y desventajas.