Abstract:
BACKGROUND:New tests, such as magnetic resonance imaging (MRI) and electron-beam computed tomography (CT), are being developed for the diagnosis of coronary artery disease. OBJECTIVE:To determine the conditions that a new test must meet to be a cost-effective alternative to established imaging tests. DESIGN:Decision model and cost-effectiveness analysis. DATA SOURCES:Literature review and meta-analysis. TARGET POPULATION:55-year-old men and 65-year-old women presenting with chest pain. TIME HORIZON:Lifetime of the patient. PERSPECTIVE:Health care policy. INTERVENTIONS:MRI, electron-beam CT, exercise echocardiography, exercise single-photon emission CT, and coronary angiography. OUTCOME MEASURES:Target sensitivity and specificity values for a new noninvasive test. RESULTS OF BASE-CASE ANALYSIS:Assuming that society is willing to pay $75000 per quality-adjusted life-year (QALY) gained, a new test that costs $1000 would need a sensitivity of 94% and a specificity of 90% to be cost-effective. RESULTS OF SENSITIVITY ANALYSIS:Assuming that society is willing to pay $50000 per QALY gained, a new test that costs $1000 or more would never be cost-effective. For a test that costs $500, the sensitivity and specificity must each be 95%. CONCLUSIONS:New imaging techniques, such as MRI and electron-beam CT, must be relatively inexpensive and have excellent sensitivity and specificity to be cost-effective compared with other techniques for the diagnosis of coronary artery disease. Similar analyses in other areas of health care may help to focus the development of new diagnostic technology.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Hunink MG,Kuntz KM,Fleischmann KE,Brady TJdoi
10.7326/0003-4819-131-9-199911020-00008subject
Has Abstractpub_date
1999-11-02 00:00:00pages
673-80issue
9eissn
0003-4819issn
1539-3704pii
199911020-00008journal_volume
131pub_type
杂志文章,meta分析abstract::Acute severe aortic regurgitation is a relatively unfamiliar, though life-threatening, disease. We review its diverse causes, anatomic faults, and hemodynamic sequelae and set the stage for an understanding of the clinical manifestations in light of their physiologic mechanisms. Clinical information includes the natur...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-87-2-223
更新日期:1977-08-01 00:00:00
abstract::We treated 50 patients who ingested packets of cocaine and developed a protocol for conservative medical management. Of the 50 patients, only 3 required emergency surgery. Surgery was precipitated by signs and symptoms of bowel obstruction in all cases. Six patients chose elective surgery. The rest of the patients pas...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-100-1-73
更新日期:1984-01-01 00:00:00
abstract::In deciding whether to undertake a dietary program to reduce serum cholesterol levels, a person must consider how much benefit to expect. We developed a model that assumes cholesterol reduction is effective and safe in reducing the risk for death from ischemic heart disease. In the model, we considered asymptomatic ad...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-106-4-605
更新日期:1987-04-01 00:00:00
abstract:BACKGROUND:Rheumatoid arthritis is associated with increased morbidity and mortality because of cardiovascular disease, independent of traditional risk factors. OBJECTIVE:To determine the prevalence of preclinical atherosclerosis in patients with rheumatoid arthritis and to identify clinical and biological markers for...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-144-4-200602210-00006
更新日期:2006-02-21 00:00:00
abstract::Polysaccharide vaccines against diseases caused by Neisseria meningitidis serogroups A and C meningococci are now licensed in the United States. They are prepared as monovalent and as bivalent antigens. This statement summarizes available information on these antigen and offers guidance regarding their role in the con...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:
更新日期:1976-02-01 00:00:00
abstract::A severe shortage of organs greatly limits the ability to deliver the miracle of transplantation to people suffering from end-stage organ disease. Contributing to this shortage is a high rate of refusal among families who are asked for permission to remove organs from a recently deceased relative. Mandated choice offe...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-125-1-199607010-00010
更新日期:1996-07-01 00:00:00
abstract::The purposes and applications of informed consent are the subject of confusion and controversy according to a President's Commission report. The Commission suggests shared decision making as the new ideal for physician-patient relationships, but notes that such a changed ideal will not be initiated by court action. Th...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-109-3-234
更新日期:1988-08-01 00:00:00
abstract::Of 5379 patients who had received radiation treatment at our institution for benign conditions of the head and neck, 318 developed thyroid cancer 3 to 42 years later. We report follow-up observations (median interval from diagnosis to recurrence or last contact, 10 years; longest interval, 31) for 296 of these patient...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-105-3-405
更新日期:1986-09-01 00:00:00
abstract::We discuss here some of the last decade's diagnostic and therapeutic advances in the treatment of lung cancer, as well as current and future research objectives. Roentgenographs from selected patients illustrate the natural history of lung cancer. We present perspectives concerning selection from the growing diagnosti...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-83-1-93
更新日期:1975-07-01 00:00:00
abstract::Subacute encephalitis caused by infection of the central nervous system by the human immunodeficiency virus (HIV) is the most frequent cause of neurologic dysfunction in patients with the acquired immunodeficiency syndrome (AIDS). This disorder results in progressive cognitive, motor, and behavioral abnormalities in a...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-107-2-383
更新日期:1987-09-01 00:00:00
abstract::Eight patients developed grand mal seizures during intravenous theophylline therapy. None had a history of neurologic disorder, and all were acutely ill with severe pulmonary or cardiovascular disease, or both. Serum theophylline concentrations obtained within 1 hour of the seizure ranged from 25 mug/ml to 70mug/ml, w...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-82-6-784
更新日期:1975-06-01 00:00:00
abstract:BACKGROUND:The magnitude, consistency, and manner of association between sedentary time and outcomes independent of physical activity remain unclear. PURPOSE:To quantify the association between sedentary time and hospitalizations, all-cause mortality, cardiovascular disease, diabetes, and cancer in adults independent ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,meta分析,评审
doi:10.7326/M14-1651
更新日期:2015-01-20 00:00:00
abstract:OBJECTIVE:To assess the use of L-tryptophan by patients with eosinophilic fasciitis and compare this with its use by patients with progressive systemic sclerosis (scleroderma). DESIGN:Retrospective and prospective analysis. Six patients with eosinophilic fasciitis were identified retrospectively and two prospectively....
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-112-10-758
更新日期:1990-05-15 00:00:00
abstract:BACKGROUND:HIV-infected patients with sustained immunologic improvement from antiretroviral therapy may be able to discontinue chemoprophylaxis against Pneumocystis carinii pneumonia (PCP). OBJECTIVE:To compare PCP incidence in HIV-infected patients who had sustained CD4+ lymphocyte counts greater than 200 cells/mm3 a...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-132-3-200002010-00005
更新日期:2000-02-01 00:00:00
abstract::A 53-year-old librarian had recurrent palpable purpura on her ankles and legs that was found to be caused by the fumes released from heat-activated photocopy paper at her place of employment. Behenic acid was identified as the responsible chemical component through a series of challenge studies that simulated her work...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-98-3-320
更新日期:1983-03-01 00:00:00
abstract:OBJECTIVE:To estimate relative risk of mortality and median life expectancy for patients with classic hemophilia by a life-table analysis, taking into account deaths that may have occurred in infancy or childhood before the onset of symptoms. DESIGN:Retrospective chart review of clinical series. SETTING:Referral-base...
journal_title:Annals of internal medicine
pub_type: 历史文章,杂志文章
doi:10.7326/0003-4819-114-8-641
更新日期:1991-04-15 00:00:00
abstract:BACKGROUND:With suspected deep venous thrombosis and normal results on proximal vein ultrasonography, a negative d-dimer result may exclude thrombosis and a positive D-dimer result may be an indication for venography. OBJECTIVE:To evaluate and compare the safety of 2 diagnostic strategies for deep venous thrombosis. ...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.7326/0003-4819-142-7-200504050-00007
更新日期:2005-04-05 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the usefulness and safety of hydroxychloroquine in patients with decompensated, treatment-refractory noninsulin-dependent diabetes mellitus. DESIGN:Prospective, randomized, placebo, double-blind 6-month trial. PATIENTS:Thirty-eight patients with noninsulin-dependent diabetes resistant to c...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-112-9-678
更新日期:1990-05-01 00:00:00
abstract::In studies of the cause of gastrointestinal symptoms in homosexual men, Campylobacter jejuni was recovered from 10 of 158 men with, and 2 of 75 men without, intestinal symptoms. In addition, a heterogeneous group of Campylobacter-like organisms was identified in 26 symptomatic and 6 asymptomatic homosexual men, but in...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-101-2-187
更新日期:1984-08-01 00:00:00
abstract:BACKGROUND:Depression collaborative care implementation using community engagement and planning (CEP) across programs improves 6-month client outcomes in minority communities, compared with technical assistance to individual programs (resources for services [RS]). However, 12-month outcomes are unknown. OBJECTIVE:To c...
journal_title:Annals of internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.7326/M13-3011
更新日期:2014-11-18 00:00:00
abstract::Of 476 patients with multiple myeloma treated during a 9-year period, 11 developed acute myelogenous leukemia or sideroblastic anemia. In all, the myeloma was in remission from chemotherapy with melphalan-prednisone combinations that had been continued for a median duration of 3 years. The incidence of acute leukemia ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-86-4-440
更新日期:1977-04-01 00:00:00
abstract::Medical technology assessment seeks to improve the care of individual patients (the conventional unit of clinical practice) through evaluation studies conducted in groups of patients (the conventional unit of clinical investigation). This distinction between individuals and groups has practical relevance to the design...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-118-6-199303150-00010
更新日期:1993-03-15 00:00:00
abstract:OBJECTIVE:To identify and describe patients with hepatotoxicity possibly caused by flutamide, an antiandrogen drug. DESIGN:Case series of reports, submitted to the Adverse Drug Event Reporting System of the Food and Drug Administration. SETTING:Outpatient clinics and physicians' offices in the United States. PATIENT...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-118-11-199306010-00006
更新日期:1993-06-01 00:00:00
abstract:OBJECTIVE:To determine the toxicity and efficacy of low-dose interferon-alpha therapy in inducing remissions and prolonging survival in patients with chronic myeloid leukemia. DESIGN:Phase II evaluation and comparison with historical control patients and other series in which the investigators used higher interferon-a...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章
doi:10.7326/0003-4819-121-10-199411150-00002
更新日期:1994-11-15 00:00:00
abstract:BACKGROUND:Increased prevalence of adolescent obesity requires effective treatment options beyond behavior therapy. OBJECTIVE:To see whether sibutramine reduced weight more than placebo in obese adolescents who were receiving a behavior therapy program. DESIGN:12-month, 3:1 randomized, double-blind trial conducted fr...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.7326/0003-4819-145-2-200607180-00005
更新日期:2006-07-18 00:00:00
abstract::The question of whether initial treatment is necessary in relatively asymptomatic patients with stage III and IV non-Hodgkin's lymphomas of favorable histologic types was studied by retrospective analysis. Two groups of patients were studied: [1] 44 nonprotocol patients, followed since 1963, in whom initial treatment ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-90-1-10
更新日期:1979-01-01 00:00:00
abstract::Anxiety commonly accompanies serious illness. However, in some patients anxiety is the primary manifestation of illness. Diagnostic criteria for these "primary" anxiety disorders have been redefined in the most recent revision of the American Psychiatric Association's Diagnostic and Statistical Manual. We discuss thes...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-100-4-558
更新日期:1984-04-01 00:00:00
abstract:BACKGROUND:Although some studies suggest that access to cardiac procedures may differ by sex, others have found no evidence of gender bias in cardiac care. OBJECTIVE:To study rates of percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery in men and women after cardiac catheterization....
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-136-10-200205210-00007
更新日期:2002-05-21 00:00:00
abstract::The 1950s witnessed prodigious growth in our knowledge of the chemical nature of the gene, the mechanisms by which the information inherent in its sequence of nucleotide units was conveyed to the cell's machinery for synthesizing proteins, and the mode of operation of that machinery. Watson and Crick raised the curtai...
journal_title:Annals of internal medicine
pub_type: 评论,历史文章,杂志文章
doi:10.7326/0003-4819-138-7-200304010-00016
更新日期:2003-04-01 00:00:00
abstract::Evidence on the safety and efficacy of methotrexate as a second- or third-line agent for treating patients with rheumatoid arthritis is reviewed. Four placebo-controlled clinical trials have documented short-term benefit from methotrexate; although true remission is rare, patients receiving methotrexate showed a 26% (...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,评审
doi:10.7326/0003-4819-107-2-358
更新日期:1987-09-01 00:00:00