To examine the costs and benefits of routine follow-up evaluation in patients treated with radiation therapy for early-stage Hodgkin's disease.
We retrospectively examined patterns of follow-up evaluation and methods of relapse detection among 709 patients with stage I and II Hodgkin's disease treated with primary radiotherapy between 1969 and 1994.
We determined the probability of relapse detection for seven routine follow-up procedures, compared their relative costs, and determined the impact of each procedure on the likelihood of survival following salvage therapy.
Relapse has occurred in 157 patients (22%) at a median 1.9 years (range, 0 to 13 years) posttreatment.
Relapse was suspected primarily by history (Hx) in 55% of patients, physical examination (PE) in 14%, chest x-ray (CXR) in 23%, and abdominal x-ray (KUB) in 7%. Only one relapse (1%) was identified by a routine laboratory study.
The rate of relapse detection was highest for a combination of Hx and PE (78 of 10,000 examinations) followed by CXR (26 of 10,000 examinations).
The projected charges (1995 dollars) per relapse detected by routine follow-up Hx and PE were $11,000 compared with $68,000 for CXR and $142,000 for KUB.
The 10-year actuarial survival rate following salvage therapy was 65% overall, 65% for patients in whom relapse was detected by Hx or PE, and 69% for patients in whom relapse was detected by radiographs (P=not significant). (...)
Mots-clés Pascal : Hodgkin maladie, Homme, Récidive, Diagnostic, Exploration clinique, Exploration radiologique, Méthodologie, Analyse coût, Economie santé, Stade précoce, Hémopathie maligne, Lymphoprolifératif syndrome, Lymphome
Mots-clés Pascal anglais : Hodgkin disease, Human, Relapse, Diagnosis, Clinical investigation, Radiologic investigation, Methodology, Cost analysis, Health economy, Early stage, Malignant hemopathy, Lymphoproliferative syndrome, Lymphoma
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0217430
Code Inist : 002B19B. Création : 21/05/1997.