The objectives of this study were to investigate the cause of dyspnoea in a sample of elderly individuals and to assess the diagnostic yield of a three-step examination algorithm for the evaluation of dyspnoea paired with a cost analysis. A total of 152 subjects were examined. A predefined diagnostic approach in three steps was carried out to find the cause of dyspnoea. Step 1 included lung spirometry and ECG; step 2 included lung diffusion capacity, echocardiography, haemoglobin and thyroid function; and step 3 included cardiac magnetic resonance imaging, chest radiography and exercise test. Of 129 subjects with dyspnoea, 68 (53%) had signs of lung disease, 27 (21%) had heart disease, a total of 43 (33%) were obese, 20 (16%) were obese without other causes of dyspnoea and five (4%) had general physical deconditioning. Twelve per cent had none of the above-mentioned potential causes of dyspnoea. Steps 1, 1 + 2 and 1 + 2 + 3 revealed a cause of dyspnoea in 39%, 63%, and 73% of subjects respectively. The cost per diagnosed case at steps 2 and 3 was twice and 3.5 times the cost per diagnosed case at step 1. In this sample of elderly subjects, a potential cause of dyspnoea was identified in most cases, the most frequent being lung disease followed by heart disease and obesity. These data shed light on the diagnostic yield that can be expected from a relatively simple diagnostic approach, including the most frequent recommended initial screening tests. As expected, the incremental nature of this algorithm translated into incremental costs per diagnosis achieved.

The proportion of consistent responses was higher than would be expected by chance. Conjoint reliability over time was found both at the input and output level.

Objective: To investigate in a prospective randomised study both long term clinical effects and cost effectiveness of percutaneous coronary interventions (PCI) with or without intravascular ultrasound (IVUS) guidance. Methods: 108 male patients with stable angina referred for PCI of a significant coronary lesion were randomly assigned to IVUS guided PCI or conventional PCI. Individual accumulated costs of the entire follow up period were calculated and compared in the randomisation groups. Effectiveness of treatment was measured by freedom from major adverse cardiac events. Results: Cost effectiveness of IVUS guided PCI that was noted at six months was maintained and even accentuated at long term follow up (median 2.5 years). The cumulated cost level was found to be lower for the IVUS guided group, with a cumulated cost of &163 672 in the IVUS guided group versus &313 706 in the coronary angiography group (p = 0.01). Throughout the study, mean cost per day was lower in the IVUS guided PCI group (&2.7 v &5.2; p = 0.01). In the IVUS group, 78% were free from major adverse cardiac events versus 59% in the coronary angiography group (p = 0.04) with an odds ratio of 2.5 in favour of IVUS guidance. Conclusion: IVUS guidance results in continued improvement of long term clinical outcome and cost effectiveness. The results of this study suggest that IVUS guidance may be used more liberally in PCI.I ntravascular ultrasound (IVUS) offers the unique opportunity of direct inspection of the coronary vessel wall, while angiography shows the lumen only. [1][2][3][4][5][6][7] In fact, IVUS imaging has shown that angiography underestimates the presence and extent of atherosclerosis. 6 8 9 Moreover, stent underexpansion can frequently be observed with IVUS despite a good angiographic result.10 11 The use of IVUS during percutaneous coronary intervention (PCI) may therefore help to optimise the results of PCI and particularly of stent implantation. In addition, IVUS provides the operator with more correct information on the real vessel size, which facilitates device selection. 12 The approach of IVUS guided PCI has previously been investigated, generally with a much shorter period of follow up, [13][14][15][16][17] but only a few cost effectiveness analyses on IVUS guidance have been published. [18][19][20][21] Most previous studies on IVUS guidance, however, have been performed in high volume centres for PCI.In the present study, we assessed the major adverse cardiac event (MACE) rate and cost effectiveness of IVUS guidance at five years after inclusion of the first patient in a relatively low volume centre for PCI. A hospital perspective was applied. Our cost effectiveness analysis addressed the cumulative costs related to the initial interventional procedure, hospitalisation, and outpatient treatment. The cost of documentary IVUS in the coronary angiography (CAG) guided group was not included. METHODS Study design and inclusion criteriaThe study was performed as a prospective randomised clinical trial. Male patients suffering f...

This paper seeks to enlighten the readers on the potential complexities involved in including cost variables in conjoint analysis, with the aim of emphasising that interpretation of implicit WTP values should be tackled with caution. To illustrate the potential pitfalls, a large data set from a recent Danish study is applied. The data consists of 1991 interviews in which participants are required to perform three discrete choice tasks regarding choice of hospitals, and three choice tasks involving health-care systems in general. Model comparisons are performed which test the effect of (1) the cost range applied and (2) the effect of including a dummy variable to represent the utility associated with payment per se. A wider cost range including higher payments is associated with lower parameter weights associated with the payment variable, and thus increased WTP values. Including a dummy variable to explain utility associated with payment per se has significant effects on the model incurring some of the other variables to become insignificant, and others to change sign. Results suggest that inclusion of a two-dimensional structure to explain the relationship between cost and utility may avoid erroneous conclusions and give rise to significant changes in implicit WTP estimates.

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