Il controllo della gestione e il bilancio operativo dell'Istituto del Radio "O. Alberti". La gestione del follow-up oncologico

Translated title of the contribution: Istituto del Radio «O. Alberti» management control and cost-benefit analysis. Oncologic follow-up management

Enrico Micheletti, Beniamino La Face, Alessandra Huscher, Gianpiero Catalano, Raffaele Spiazzi

Research output: Contribution to journalArticle

Abstract

Post-treatment cancer patient surveillance is an area with few given standards where the need of guidelines has become imperative with the recent emphasis on controlling the ever-increasing health care cost. Unfortunately, literature reports are often inconclusive and ambiguous, mostly because of the lack of properly controlled trials comparing the cost and benefits of various follow-up protocols. In addition, the actual impact on patient survival and quality of life is questionable. At the Istituto del Radio «O. Alberti» (IRA), we consider the follow-up as a sort of population screening aimed at the early detection and treatment of recurrent disease. While aggressive surveillance undoubtedly detects some cancers before symptoms develop, it is debated whether the impact on survival and quality of life are measurable. The early detection of relapse is only a potential survival benefit if recurrent disease is curable with further treatment or at least if salvage treatment is more effective in patients with less severe disease. We investigated the effectiveness, efficacy and medical care of our follow-up protocol. April to June, 1996, we examined 1,223 of 2,148 expected patients; 225 patients disattended the scheduled visits. IRA spent about It. L. 33,800 per examination. Fifty-seven patients were hospitalized to carry out treatment and IRA hospitalization charges were about It. L. 1,100,000 while overall social expenses were about It. L. 6,600,000. Regular visits to see an oncologist provide easy access to specialist medicine and convey a sense of being looked after with a caring system. 94.5% of patients prefers to continue the follow-up program with scheduled visits. Most patients (70%) know about the examinations they undergo but consistently overestimate the importance of laboratory tests and imaging findings and underestimate the importance of medical history and physical examination. In addition, most patients (95%) misinterpret the term «normal» relative to a test result. This study suggests that patients are unfamiliar with the limitations of more costly diagnostic and follow-up studies, which reflects the fact that physicians spend little time discussing follow-up strategies with their patients, especially regarding the cost-benefit analysis and the sensitivity and specificity of the laboratory tests and imaging examinations. Finally, in our opinion follow-up cost is acceptable even though expenses should be reduced optimizing the request of instrumental examinations. Therefore, oncologists should definitely try to inform their patients about the clinical importance of follow-up.

Original languageItalian
Pages (from-to)267-272
Number of pages6
JournalRadiologia Medica
Volume93
Issue number3
Publication statusPublished - Mar 1997

Fingerprint

Radio
Cost-Benefit Analysis
Survival
Quality of Life
Salvage Therapy
Aftercare
Therapeutics
Health Care Costs
Physical Examination
Neoplasms
Hospitalization
Medicine
Guidelines
Physicians
Costs and Cost Analysis
Recurrence
Sensitivity and Specificity

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Micheletti, E., La Face, B., Huscher, A., Catalano, G., & Spiazzi, R. (1997). Il controllo della gestione e il bilancio operativo dell'Istituto del Radio "O. Alberti". La gestione del follow-up oncologico. Radiologia Medica, 93(3), 267-272.

Il controllo della gestione e il bilancio operativo dell'Istituto del Radio "O. Alberti". La gestione del follow-up oncologico. / Micheletti, Enrico; La Face, Beniamino; Huscher, Alessandra; Catalano, Gianpiero; Spiazzi, Raffaele.

In: Radiologia Medica, Vol. 93, No. 3, 03.1997, p. 267-272.

Research output: Contribution to journalArticle

Micheletti, E, La Face, B, Huscher, A, Catalano, G & Spiazzi, R 1997, 'Il controllo della gestione e il bilancio operativo dell'Istituto del Radio "O. Alberti". La gestione del follow-up oncologico', Radiologia Medica, vol. 93, no. 3, pp. 267-272.
Micheletti, Enrico ; La Face, Beniamino ; Huscher, Alessandra ; Catalano, Gianpiero ; Spiazzi, Raffaele. / Il controllo della gestione e il bilancio operativo dell'Istituto del Radio "O. Alberti". La gestione del follow-up oncologico. In: Radiologia Medica. 1997 ; Vol. 93, No. 3. pp. 267-272.
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