Estudio descriptivo de costes en melanoma cutáneo de diferentes estadios / Cost of cutaneous melanoma by tumor stage: a descriptive analysis

INTRODUCCIÓN Y OBJETIVO: El conocimiento de los recursos utilizados en cada uno de los pasos del diagnóstico y tratamiento de las enfermedades es la base para poder optimizarlos. El melanoma cutáneo es un tipo tumoral en constante incremento, y con un importante coste asociado, por lo que se ha realizado un análisis actualizado de los costes de los procesos de su diagnóstico, terapia y seguimiento en función del estadio de la enfermedad. MÉTODOS: Se han elaborado tablas descriptivas de costes directos a partir de un modelo teórico basado en directrices nacionales e internacionales de manejo de pacientes con melanoma cutáneo dependiendo del momento de diagnóstico y evolución. Estas tablas permiten saber el coste de cada paciente individual y de todos aquellos en un mismo estadio. RESULTADOS: Los costes para un paciente en el primer ańo oscilan entre los 1.689 Euros del estadio I y los 88.268 Euros del estadio IV, las mayores diferencias se encuentran entre el estadio IA y el IB-IIA y entre el III y IV. Si comparamos los costes de los pacientes en estadio precoz con buena evolución con los de aquellos que recidivaron, las diferencias son considerables: llegan a ser de hasta 50 veces mayores en el primer ańo y 20 veces mayores en el seguimiento a 10 ańos. CONCLUSIONES: Los elevados costes del diagnóstico del melanoma cutáneo en estadio avanzado evidencian la necesidad de promocionar la prevención primaria y los programas de detección precoz. Nuestros resultados servirán como base para posteriores estudios de coste-efectividad

BACKGROUND AND OBJECTIVE: The basis for optimal resource allocation is an understanding of requirements during the diagnostic and treatment phases. Costs associated with the rising incidence of cutaneous melanoma are considerable. We undertook an up-to-date analysis of the cost of diagnosis, treatment, and follow-up according to tumor stage. METHODS: We constructed descriptive tables following a theoretical model of direct costs based on amounts published in directives for the Spanish national health system and in international guidelines for managing cutaneous melanoma according to stage at diagnosis and clinical course. The tables allowed us to calculate the cost of treating individual patients as well as the expected cost for all patients with tumors in the same stage. RESULTS: Individual patients would generate costs ranging from Euros 1689 (for a stage I tumor) to Euros 88, 268 (stage IV). The largest differences were between stages IA and IB-IIA and between stages III and IV. Costs differed greatly between patients with early-stage tumors and favorable outcomes and those with recurring tumors, which cost 50-fold more in the first year and 20-fold more after 10 years of follow-up. CONCLUSIONS: The high cost of diagnosing advanced-stage cutaneous melanoma calls attention to the need to promote primary prevention and early detection. Our findings provide the knowledge base for cost-effectiveness studies in this disease

Cost of Cutaneous Melanoma by Tumor Stage: A Descriptive Analysis. / Estudio descriptivo de costes en melanoma cutáneo de diferentes estadios.

BACKGROUND AND OBJECTIVE: The basis for optimal resource allocation is an understanding of requirements during the diagnostic and treatment phases. Costs associated with the rising incidence of cutaneous melanoma are considerable. We undertook an up-to-date analysis of the cost of diagnosis, treatment, and follow-up according to tumor stage. METHODS: We constructed descriptive tables following a theoretical model of direct costs based on amounts published in directives for the Spanish national health system and in international guidelines for managing cutaneous melanoma according to stage at diagnosis and clinical course. The tables allowed us to calculate the cost of treating individual patients as well as the expected cost for all patients with tumors in the same stage. RESULTS: Individual patients would generate costs ranging from €1689 (for a stage I tumor) to €88, 268 (stage IV). The largest differences were between stages IA and IB-IIA and between stages III and IV. Costs differed greatly between patients with early-stage tumors and favorable outcomes and those with recurring tumors, which cost 50-fold more in the first year and 20-fold more after 10 years of follow-up. CONCLUSIONS: The high cost of diagnosing advanced-stage cutaneous melanoma calls attention to the need to promote primary prevention and early detection. Our findings provide the knowledge base for cost-effectiveness studies in this disease.

Discrepancies on quality perceived by the patients versus professionals on the quality of a nuclear medicine department / Discrepancias sobre la calidad percibida entre los profesionales y los pacientes de un servicio de medicina nuclear

Purpose: To evaluate the discrepancies between the professionals and outpatients on quality perceived of a Nuclear Medicine Department (NMD). Material and Methods: This cross-sectional study has been carried out using two questionnaires: a validated patient experience questionnaire and a quality perception questionnaire for professionals. Both questionnaires use the same 25 categorical items to measure service quality, 2 Likert scale items to measure satisfaction and willingness to recommend the NMD and 1 open-ended question. The patient questionnaire included 6 socio-demographic items and one job-related question (professionals). The categorical items were classified as 'conformity' or 'non-conformity.' Results: The response rate was 36.7% for outpatients and 100% for professionals. Mean value for satisfaction with the NMD was 9 points for patients and 6.9 points for professionals. Mean number of non-conformity items per person was 2.8 for the patient group and 8.7 for the professional group. Cohen’s Kappa value was 0.112, indicating poor agreement in the classification of items as strong points and areas for improvement. Of the 25 items, the professionals and patients coincided on 12 (48%). Conclusion: Agreement was low between the quality perception of patients and professionals. The patients scored quality of service higher than the NMD professionals did. These instruments are useful aid to help health organizations detect areas for improvement, and to improve the quality of the service provided to patients (AU)

Objetivo: Evaluar las discrepancias entre los profesionales y los pacientes de un Servicio de Medicina Nuclear sobre la calidad percibida. Material y métodos: Se realizó un estudio transversal utilizando 2 tipos de cuestionarios: un cuestionario validado para explorar experiencias y satisfacción de los pacientes y un cuestionario adaptado para evaluar la percepción de los profesionales. Ambos cuestionarios constaron de 25 preguntas categóricas (calidad de servicio), 2 con escala de Likert (satisfacción y recomendación) y una pregunta abierta. Se incluyeron 6 variables sociodemográficas (pacientes) y una sobre ámbito laboral (profesionales). Las preguntas categóricas fueron clasificadas como 'conformidad' o 'no conformidad'. Resultados: La tasa de respuesta fue del 36,7% para los pacientes y del 100% para los profesionales. La satisfacción alcanzó una media de 9 puntos para los pacientes y de 6,9 para los profesionales. La media de no-confomidades por persona fue de 2,8 para el grupo de pacientes y de 8,7 para el de profesionales. El valor Kappa de Cohen fue de 0,112 indicando un pobre acuerdo a la hora de clasificar los ítems en punto fuertes o áreas de mejora. De los 25 ítems, los pacientes y los profesionales coincidieron en 12 (48%). Conclusión: El grado de acuerdo entre los pacientes y los profesionales sobre la percepción de la calidad ofrecida fue bajo. Los pacientes puntuaron mejor la calidad ofrecida que los profesionales. Estos instrumentos son útiles para ayudar a las organizaciones sanitarias a detectar áreas de mejora y mejorar la calidad de servicio que se ofrece a los pacientes (AU)

Discrepancies on quality perceived by the patients versus professionals on the quality of a nuclear medicine department.

PURPOSE: To evaluate the discrepancies between the professionals and outpatients on quality perceived of a Nuclear Medicine Department (NMD). MATERIAL AND METHODS: This cross-sectional study has been carried out using two questionnaires: a validated patient experience questionnaire and a quality perception questionnaire for professionals. Both questionnaires use the same 25 categorical items to measure service quality, 2 Likert scale items to measure satisfaction and willingness to recommend the NMD and 1 open-ended question. The patient questionnaire included 6 socio-demographic items and one job-related question (professionals). The categorical items were classified as "conformity" or "non-conformity." RESULTS: The response rate was 36.7% for outpatients and 100% for professionals. Mean value for satisfaction with the NMD was 9 points for patients and 6.9 points for professionals. Mean number of non-conformity items per person was 2.8 for the patient group and 8.7 for the professional group. Cohen's Kappa value was 0.112, indicating poor agreement in the classification of items as strong points and areas for improvement. Of the 25 items, the professionals and patients coincided on 12 (48%). CONCLUSION: Agreement was low between the quality perception of patients and professionals. The patients scored quality of service higher than the NMD professionals did. These instruments are useful aid to help health organizations detect areas for improvement, and to improve the quality of the service provided to patients.

Evaluación de la eficacia en la detección del ganglio centinela en el cáncer de mama: evolución cronológica e influencia de la incorporación de una gammacámara portátil intraoperatoria / Evaluation of the efficacy of sentinel node detection in breast cancer: chronological course and influence of the incorporation of an intra-operative portable gamma camera

Objetivo. Determinar el porcentaje de identificación global del ganglio centinela (GC) en el cáncer de mama, la evolución cronológica de este parámetro y la influencia de la introducción de una gammacámara portátil. Material y métodos. Estudio retrospectivo a partir de una base de datos prospectiva de 754 pacientes a las que se realizó biopsia selectiva del GC de forma consecutiva entre enero de 2003 y diciembre de 2011. La técnica fue mixta en periodo inicial y posteriormente con radiotrazador administrado intra-peritumoralmente. Hasta octubre de 2009 la exéresis del GC fue guiada por sonda y a partir de esta fecha se introdujo una gammacámara portátil para la detección intraoperatoria. Resultados. Se ha biopsiado el GC en 725 de 754 pacientes, siendo por tanto la eficacia global del 96,2%. Según el año de intervención quirúrgica los porcentajes de identificación han sido del 93,5% en 2003, del 88,7% en 2004, del 94,3% en 2005, del 95,7% en 2006, del 93,3% en 2007, del 98,8% en 2008, del 97,1% en 2009 y del 99,1% en 2010 y 2011. Existe una diferencia de proporciones entre el porcentaje de identificación antes y después de la incorporación de la gammacámara portátil del 4,6% que es estadísticamente significativa (IC 95% de la diferencia 2-7,2% con una p asociada de 0,0037). Conclusiones. El porcentaje de identificación global se halla por encima del nivel recomendado por las directrices actuales. Cronológicamente se constata elevación de este parámetro a lo largo del periodo estudiado. Los datos apuntan a que la incorporación de una gammacámara portátil ha tenido un papel en ello (AU)

Aim. To define the sentinel node identification rate in breast cancer, the chronological evolution of this parameter and the influence of the introduction of a portable gamma camera. Material and methods. A retrospective study was conducted using a prospective database of 754 patients who had undergone a sentinel lymph node biopsy between January 2003 and December 2011. The technique was mixed in the starting period and subsequently was performed with radiotracer intra-peritumorally administered the day before of the surgery. Until October 2009, excision of the sentinel node was guided by a probe. After that date, a portable gamma camera was introduced for intrasurgical detection. Results. The SN was biopsied in 725 out of the 754 patients studied. The resulting technique global effectiveness was 96.2%. In accordance with the year of the surgical intervention, the identification percentage was 93.5% in 2003, 88.7% in 2004, 94.3% in 2005, 95.7% in 2006, 93.3% in 2007, 98.8% in 2008, 97.1% in 2009 and 99.1% in 2010 and 2011. There was a significant difference in the proportion of identification before and after the incorporation of the portable gamma camera of 4.6% (95% CI of the difference 2–7.2%, P = 0.0037). Conclusions. The percentage of global identification exceeds the recommended level following the current guidelines. Chronologically, the improvement for this parameter during the study period has been observed. These data suggest that the incorporation of a portable gamma camera had an important role (AU)

[Evaluation of the efficacy of sentinel node detection in breast cancer: chronological course and influence of the incorporation of an intra-operative portable gamma camera]. / Evaluación de la eficacia en la detección del ganglio centinela en el cáncer de mama: evolución cronológica e influencia de la incorporación de una gammacámara portátil intraoperatoria.

AIM: To define the sentinel node identification rate in breast cancer, the chronological evolution of this parameter and the influence of the introduction of a portable gamma camera. MATERIAL AND METHODS: A retrospective study was conducted using a prospective database of 754 patients who had undergone a sentinel lymph node biopsy between January 2003 and December 2011. The technique was mixed in the starting period and subsequently was performed with radiotracer intra-peritumorally administered the day before of the surgery. Until October 2009, excision of the sentinel node was guided by a probe. After that date, a portable gamma camera was introduced for intrasurgical detection. RESULTS: The SN was biopsied in 725 out of the 754 patients studied. The resulting technique global effectiveness was 96.2%. In accordance with the year of the surgical intervention, the identification percentage was 93.5% in 2003, 88.7% in 2004, 94.3% in 2005, 95.7% in 2006, 93.3% in 2007, 98.8% in 2008, 97.1% in 2009 and 99.1% in 2010 and 2011. There was a significant difference in the proportion of identification before and after the incorporation of the portable gamma camera of 4.6% (95% CI of the difference 2-7.2%, P = 0.0037). CONCLUSIONS: The percentage of global identification exceeds the recommended level following the current guidelines. Chronologically, the improvement for this parameter during the study period has been observed. These data suggest that the incorporation of a portable gamma camera had an important role.

[Assessment of the patient satisfaction with a Nuclear Medicine Service]. / Evaluación del grado de satisfacción de los pacientes atendidos en un servicio de Medicina Nuclear.

GOAL: To know the perceived quality and the levels of patient satisfaction with the Nuclear Medicine Service (MN). METHODS: A cross-sectional descriptive study was performed. The authors designed a self-applied questionnaire based on a questionnaire from a survey created by the National Health Service of the UK. The answers of 32 items were analyzed, including 4 social-demographic questions and one open question. The authors recoded the variables related to service quality and recorded them as "in accordance" and "not in accordance." The validity of the questionnaire was measured using Cronbach's alpha and determination (R(2)) indexes. The authors used the χ(2), Student's T, ANOVA and linear regression analysis statistical tests. RESULTS: A total of 179 questionnaires were analyzed (response rate: 36.6%, sampling error: 5.8%). Evaluation of general satisfaction and the recommendation of the NM Service obtained a mean score of 8.96 and 9.20 (1-10 scale) points, respectively. The most influential variable regarding general satisfaction was the general impression of the organization of the service. The strong points of the service were courtesy, general organizational image and cleanliness. The main areas for improvement were appointment change process and waiting list. There were no significant differences regarding satisfaction due to the social-demographic variables except for age. CONCLUSION: This satisfaction survey has shown that patients are satisfied with the Nuclear Medicine Service and that it is a useful tool to detect the strong points and areas for improvement of the Service from the user's perspective.

Evaluación del grado de satisfacción de los pacientes atendidos en un servicio de Medicina Nuclear / Assessment of the Patient Satisfaction with a Nuclear Medicine Service

Objetivo. Conocer la calidad percibida y el grado de satisfacción de los pacientes con el servicio de Medicina Nuclear (MN). Metodología. Estudio descriptivo transversal. Se diseñó un cuestionario, adaptando un cuestionario elaborado por el National Health Service. Se analizaron las respuestas de 32 ítems, incluyendo 4 preguntas socio-demográficas y una abierta. Las variables relacionadas con la calidad de servicio se recodificaron en conformidad y no conformidad. Se midió la validez del cuestionario a través de los coeficientes alfa de Cronbach y de determinación (R2). Se utilizaron los test estadísticos χ2, t de Student, ANOVA y análisis de regresión lineal. Resultados. Fueron analizados 179 cuestionarios (tasa de respuesta: 36,6%, error muestral: 5,8%). La valoración de la satisfacción general y la recomendación del servicio de MN obtuvieron una puntuación media de 8,96 y 9,20 puntos respectivamente (escala 1-10). La variable que más influyó en la satisfacción general fue la impresión de la organización del servicio. Los principales puntos fuertes del servicio fueron la cortesía, la impresión de la organización del servicio y la limpieza; y las principales áreas de mejora, el cambio de cita y la lista de espera. No hubo diferencias significativas en la satisfacción en función de las variables sociodemográficas excepto para la edad. Conclusiones. La encuesta de satisfacción realizada nos ha permitido conocer que los pacientes están satisfechos con el Servicio de MN y, al mismo tiempo, constituye un instrumento útil para poder detectar los puntos fuertes y áreas de mejora del servicio desde la óptica del usuario(AU)

Goal. To know the perceived quality and the levels of patient satisfaction with the Nuclear Medicine Service (MN). Methods. A cross-sectional descriptive study was performed. The authors designed a self-applied questionnaire based on a questionnaire from a survey created by the National Health Service of the UK. The answers of 32 items were analyzed, including 4 social-demographic questions and one open question. The authors recoded the variables related to service quality and recorded them as "in accordance" and "not in accordance". The validity of the questionnaire was measured using Cronbach's alpha and determination (R2) indexes. The authors used the χ2, Student's T, ANOVA and linear regression analysis statistical tests. Results. A total of 179 questionnaires were analyzed (response rate: 36.6%, sampling error: 5.8%). Evaluation of general satisfaction and the recommendation of the NM Service obtained a mean score of 8.96 and 9.20 (1-10 scale) points, respectively. The most influential variable regarding general satisfaction was the general impression of the organization of the service. The strong points of the service were courtesy, general organizational image and cleanliness. The main areas for improvement were appointment change process and waiting list. There were no significant differences regarding satisfaction due to the social-demographic variables except for age. Conclusion. This satisfaction survey has shown that patients are satisfied with the Nuclear Medicine Service and that it is a useful tool to detect the strong points and areas for improvement of the Service from the user‘s perspective(AU)

Hallazgo casual de un timoma en un estudio de perfusión miocárdica con 99mTc-tetrofosmin / No disponible

No disponible

[Metastatic gastroenteropancreatic neuroendocrine tumours: 111In-pentetreotide and PET-FDG imaging]. / Tumor neuroendocrino del sistema gastroenteropancreático metastásico: imagen con 111In-pentetreótido y PET-FDG.

We present a patient with previous history of neuroendocrine tumour in the head of the pancreas, well differentiated and treated surgically. Two years later, there was suspicion of relapse. An endoscopy, CT scan and 111In-pentetreotide scintigraphy were performed. The 4 hour image showed two uptake lesions in the liver and the peripancreatic region. However, these focal uptakes had disappeared in the 24 hour image. In view of this result, a PET-FDG scan was carried out, showing two hypermetabolic lesions. The biodistribution of 111In-pentetreotide may be influenced by various parameters, including the time of scanning, and may show neuroendocrine tumours without somatostatin receptors in relapses. PET-FDG is an interesting tool to help characterise these cases.

Tumor neuroendocrino del sistema gastroenteropancreático metastásico: imagen con 111In-pentetreótido y PET-FDG / Metastatic gastroenteropancreatic neuroendocrine tumours: 111in-pentetreotide and PET-FDG imaging

Presentamos el caso de una paciente con el antecedente de un tumor neuroendocrino de la cabeza del páncreas, bien diferenciado, que es tratada mediante cirugía. Dos años después, ante la sospecha clínica de recidiva se le practica una endoscopia, una TAC y un rastreo con 111In-pentetreótido. En la imagen de las 4 horas se observaron lesiones con receptores de somatostatina en el hígado y en la región peripancreática. No obstante, esta captación desaparece a las 24 horas. Ante este hallazgo se realiza una PET-FDG mostrando focos de elevado metabolismo en ambas lesiones. La biodistribución del 111In-pentetreótido puede ser variable en el tiempo, y ser captada por tumores sin expresión previa de receptores de somatostatina en las recidivas. La PET-FDG puede ayudar en estos casos (AU)

We present a patient with previous history of neuroendocrine tumour in the head of the pancreas, well differentiated and treated surgically. Two years later, there was suspicion of relapse. An endoscopy, CT scan and 111In-pentetreotide scintigraphy were performed. The 4 hour image showed two uptake lesions in the liver and the peripancreatic region. However, these focal uptakes had disappeared in the 24 hour image. In view of this result, a PET-FDG scan was carried out, showing two hypermetabolic lesions. The biodistribution of 111In-pentetreotide may be influenced by various parameters, including the time of scanning, and may show neuroendocrine tumours without somatostatin receptors in relapses. PET-FDG is an interesting tool to help characterise these cases (AU)