Objective: To determine cost-effectiveness of preoperative lymphoscintigraphy (LSG) for detection of inguinofemoral sentinel lymph nodes (SLN).
Method: We compared the use of preoperative LSG prior to SLN excision versus omission of preoperative LSG. The two outcomes were death or survival. Costs associated with the procedure were determined by CPT code and published estimates. Cost analysis was performed using Treeage software, and incremental cost-effectiveness ratios (ICERs) were calculated. The measure of effectiveness was incremental survival benefit. ICER thresholds for considering LSG to be cost-effective were based on the value of a statistical life (VSL).
Results: Using a baseline probability of 0.93 for finding SLN with LSG, our model estimated LSG costs were $2783.84 with 84.7% survival. Our model then estimated the cost and survival without LSG by varying the SLN detection rate. Survival was equivalent when probability of SLN detection without LSG was 0.93. If detection without LSG was >0.93, not performing LSG was the dominant strategy. Costs were equal when probability of finding SLN without LSG was 0.6. For any SLN detection without LSG below 0.6, performing LSG was the dominant strategy. Formal cost-effectiveness analysis was performed using ICERs for probabilities from 0.60 to 0.93. In this range, costs were higher with LSG, but survival was improved. As long as the incremental detection with LSG was at least 1.05% to 1.47% higher, LSG was cost-effective with ICERs below the VSL.
Conclusion: In our model, LSG is cost-effective as long as it increases detection of SLN by at least 1.05-1.47%.
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http://dx.doi.org/10.1016/j.ygyno.2020.08.023 | DOI Listing |
Nutrients
December 2024
Department of Pharmaceutical Botany, Faculty of Pharmacy, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania.
Micronutrient deficiencies (MNDs) are commonly reported after bariatric and metabolic surgery, including laparoscopic sleeve gastrectomy (LSG). Nevertheless, the micronutrient status changes over time and the influence of sex or initial body mass index (BMI) on these changes are less explored. This study aims to investigate the changes in micronutrient levels at 6 and 12 months after LSG and the potential influence of sex or baseline BMI (≥40 kg/m) on these changes in patients submitted to LSG.
View Article and Find Full Text PDFJ Vasc Surg Venous Lymphat Disord
January 2025
The RANE Center for Venous & Lymphatic Diseases, St. Dominic Hospital, Jackson, MS. Electronic address:
Objectives: Phlebolymphedema, the most common cause of secondary lymphedema in Western societies, seldom gets the attention it deserves. Diagnosis is often missed and when evaluated is through lymphoscintigraphy (LSG) which is cumbersome. This study aims to assess the role of computed tomography (CT) scanning in the diagnosis of phlebolymphedema of the lower extremities by comparing CT characteristics to the International Society of Lymphology (ISL) grading system and LSG.
View Article and Find Full Text PDFInt J Emerg Med
January 2025
Department of general surgry, Faculty of medicine, Misr university for science and technology, Giza, Egypt.
Introduction: The coexistence of gallbladder (LSG) and adenomyomatosis (ADM) is extremely uncommon presenting a novel clinical dilemma that has not been previously documented. LSG refers to a anomaly where the gallbladder is situated to the left of the round ligament deviating from its usual position. This anomaly is rare, with reported occurrences ranging between 0.
View Article and Find Full Text PDFNat Commun
January 2025
The MOE Key Laboratory of Biosystems Homeostasis & Protection, Zhejiang Provincial Key Laboratory for Cancer Molecular Cell Biology, Life Sciences Institute, Zhejiang University, Hangzhou, Zhejiang, 310058, China.
Roles of liver-specific genes (LSGs) in tumor initiation and progression are rarely explored in hepatocellular carcinoma (HCC). Here we show that LSGs are generally downregulated in HCC tumor tissues compared to non-HCC liver tissues, and low-LSG HCCs show poor prognosis and the activated c-Myc pathway. Among the c-Myc- and patient prognosis-associated LSGs, PGRMC1 significantly blocks c-Myc-induced orthotopic HCC formation.
View Article and Find Full Text PDFEnter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!