Budget impact of using midnight salivary cortisol in the diagnosis of hypercortisolism

Background A single midnight serum cortisol (MSC) test has been reported to possess the best sensitivity and specificity for diagnosing Cushing's syndrome (CS). However, this test requires patient hospitalization, making it costly. This paper aims to compare the hospital budget impact and accur...

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Autores: León Justel, Antonio, Mangas, Miguel Ángel, Infante Fontán, Rocío, Castro Luque, Jovanna, Venegas Moreno, Eva, Madrazo Atutxa, Ainara, Herrera del Rey, Teresa, Martín Rodríguez, Juan Francisco, Soto Moreno, Alfonso Manuel, Leal Cerro, Alfonso
Formato: artículo
Estado:Versión aceptada para publicación
Fecha de publicación:2011
País:España
Recursos:Universidad de Sevilla (US)
Repositorio:idUS. Depósito de Investigación de la Universidad de Sevilla
OAI Identifier:oai:idus.us.es:11441/154798
Acesso em linha:https://hdl.handle.net/11441/154798
https://doi.org/10.1016/j.cca.2011.08.013
Access Level:acceso abierto
Palavra-chave:Cushing's syndrome
Salivary cortisol
Serum cortisol
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spelling Budget impact of using midnight salivary cortisol in the diagnosis of hypercortisolismLeón Justel, AntonioMangas, Miguel ÁngelInfante Fontán, RocíoCastro Luque, JovannaVenegas Moreno, EvaMadrazo Atutxa, AinaraHerrera del Rey, TeresaMartín Rodríguez, Juan FranciscoSoto Moreno, Alfonso ManuelLeal Cerro, AlfonsoCushing's syndromeSalivary cortisolSerum cortisolBackground A single midnight serum cortisol (MSC) test has been reported to possess the best sensitivity and specificity for diagnosing Cushing's syndrome (CS). However, this test requires patient hospitalization, making it costly. This paper aims to compare the hospital budget impact and accuracy of using midnight salivary cortisol (MSVC), as opposed to MSC, in the diagnosis of hypercortisolism. Methods 77 patients with at least two high urinary free cortisol (UFC) values (> 360 nmol/24 h) were selected from 611 patients with clinical symptoms of CS. The costs of the method to confirm the diagnosis of hypercortisolism was calculated comparing Option A using MSC (UFCx2, low-dose dexamethasone suppression test [LDDST]) that requires patient hospitalization versus Option B using MSVC (UFCx2, LDDST) in which the evaluation is done outside the Hospital. A budget impact analysis for one year was developed, and a sensitivity analysis in different scenarios was performed. Reproducibility and diagnostic performance of MSVC and MSC were also measured. Results Salivary cortisol is a sound analytical method for evaluating free serum cortisol due to its classification accuracy, good imprecision, linearity, and stability. AUCROC comparison between MSVC and MSC shows no significant differences. The substitution of the MSC for MSVC in our hospital could save between €16,762 and €132,804 in one year. Conclusions The use of MSVC in the diagnosis of hypercortisolism can result in a substantial decrease in the budget impact, without losing diagnosis accuracy and reliability, a significant advantage considering the current emphasis on reducing the financial burden of health care.Fondo de Investigación Sanitaria (FIS) ETES PI08/90541 2009–2010Plan Andaluz de Investigación CTS-444ElsevierMedicinaFondo de Investigación Sanitaria (FIS)Plan Andaluz de Investigación2011info:eu-repo/semantics/articleinfo:eu-repo/semantics/acceptedVersionapplication/pdfapplication/pdfhttps://hdl.handle.net/11441/154798https://doi.org/10.1016/j.cca.2011.08.013reponame:idUS. Depósito de Investigación de la Universidad de Sevillainstname:Universidad de Sevilla (US)InglésETES PI08/90541 2009–2010CTS-444https://doi.org/10.1016/j.cca.2011.08.013info:eu-repo/semantics/openAccessoai:idus.us.es:11441/1547982026-06-17T12:51:07Z
dc.title.none.fl_str_mv Budget impact of using midnight salivary cortisol in the diagnosis of hypercortisolism
title Budget impact of using midnight salivary cortisol in the diagnosis of hypercortisolism
spellingShingle Budget impact of using midnight salivary cortisol in the diagnosis of hypercortisolism
León Justel, Antonio
Cushing's syndrome
Salivary cortisol
Serum cortisol
title_short Budget impact of using midnight salivary cortisol in the diagnosis of hypercortisolism
title_full Budget impact of using midnight salivary cortisol in the diagnosis of hypercortisolism
title_fullStr Budget impact of using midnight salivary cortisol in the diagnosis of hypercortisolism
title_full_unstemmed Budget impact of using midnight salivary cortisol in the diagnosis of hypercortisolism
title_sort Budget impact of using midnight salivary cortisol in the diagnosis of hypercortisolism
dc.creator.none.fl_str_mv León Justel, Antonio
Mangas, Miguel Ángel
Infante Fontán, Rocío
Castro Luque, Jovanna
Venegas Moreno, Eva
Madrazo Atutxa, Ainara
Herrera del Rey, Teresa
Martín Rodríguez, Juan Francisco
Soto Moreno, Alfonso Manuel
Leal Cerro, Alfonso
author León Justel, Antonio
author_facet León Justel, Antonio
Mangas, Miguel Ángel
Infante Fontán, Rocío
Castro Luque, Jovanna
Venegas Moreno, Eva
Madrazo Atutxa, Ainara
Herrera del Rey, Teresa
Martín Rodríguez, Juan Francisco
Soto Moreno, Alfonso Manuel
Leal Cerro, Alfonso
author_role author
author2 Mangas, Miguel Ángel
Infante Fontán, Rocío
Castro Luque, Jovanna
Venegas Moreno, Eva
Madrazo Atutxa, Ainara
Herrera del Rey, Teresa
Martín Rodríguez, Juan Francisco
Soto Moreno, Alfonso Manuel
Leal Cerro, Alfonso
author2_role author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Medicina
Fondo de Investigación Sanitaria (FIS)
Plan Andaluz de Investigación
dc.subject.none.fl_str_mv Cushing's syndrome
Salivary cortisol
Serum cortisol
topic Cushing's syndrome
Salivary cortisol
Serum cortisol
description Background A single midnight serum cortisol (MSC) test has been reported to possess the best sensitivity and specificity for diagnosing Cushing's syndrome (CS). However, this test requires patient hospitalization, making it costly. This paper aims to compare the hospital budget impact and accuracy of using midnight salivary cortisol (MSVC), as opposed to MSC, in the diagnosis of hypercortisolism. Methods 77 patients with at least two high urinary free cortisol (UFC) values (> 360 nmol/24 h) were selected from 611 patients with clinical symptoms of CS. The costs of the method to confirm the diagnosis of hypercortisolism was calculated comparing Option A using MSC (UFCx2, low-dose dexamethasone suppression test [LDDST]) that requires patient hospitalization versus Option B using MSVC (UFCx2, LDDST) in which the evaluation is done outside the Hospital. A budget impact analysis for one year was developed, and a sensitivity analysis in different scenarios was performed. Reproducibility and diagnostic performance of MSVC and MSC were also measured. Results Salivary cortisol is a sound analytical method for evaluating free serum cortisol due to its classification accuracy, good imprecision, linearity, and stability. AUCROC comparison between MSVC and MSC shows no significant differences. The substitution of the MSC for MSVC in our hospital could save between €16,762 and €132,804 in one year. Conclusions The use of MSVC in the diagnosis of hypercortisolism can result in a substantial decrease in the budget impact, without losing diagnosis accuracy and reliability, a significant advantage considering the current emphasis on reducing the financial burden of health care.
publishDate 2011
dc.date.none.fl_str_mv 2011
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/acceptedVersion
format article
status_str acceptedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/11441/154798
https://doi.org/10.1016/j.cca.2011.08.013
url https://hdl.handle.net/11441/154798
https://doi.org/10.1016/j.cca.2011.08.013
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv ETES PI08/90541 2009–2010
CTS-444
https://doi.org/10.1016/j.cca.2011.08.013
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Elsevier
publisher.none.fl_str_mv Elsevier
dc.source.none.fl_str_mv reponame:idUS. Depósito de Investigación de la Universidad de Sevilla
instname:Universidad de Sevilla (US)
instname_str Universidad de Sevilla (US)
reponame_str idUS. Depósito de Investigación de la Universidad de Sevilla
collection idUS. Depósito de Investigación de la Universidad de Sevilla
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,198674

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