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The use of CT scanning in dementia: A systematic review

The use of CT scanning in dementia: A systematic review
The use of CT scanning in dementia: A systematic review

While reversible cases of dementia are rare once detected, the patient may benefit from treatment. This paper examines the cost-effectiveness of computerized tomography (CT) scanning as a screening test for potentially reversible dementia. A systematic review was carried out to identify the proportion of patients with dementia above and below the age of 65 years with a theoretically treatable condition and the proportion of these patients who would benefit from neurosurgery. Information was combined with epidemiological and financial data relating to Scotland to model the costs and benefits of implementing a national screening program. Subdural hematoma, normal pressure hydrocephalus, and brain tumours are rare conditions treatable by neurosurgery. A scanning and treatment program for Scotland would cost 4.6 million Pounds per annum. Of 531 reversible cases detected, 136 would benefit from neurosurgery, 369 would not benefit, and 26 would die as a result of surgery. Treating normal pressure hydrocephalus reduces overall quality-adjusted survival. The most cost effective screening strategy is to scan all patients but treat only subdural hematomas, gaining 178 quality-adjusted life-years (QALYs) at a cost of 14,171 Pounds per QALY for patients aged 65 at the time of the scan. The corresponding figures for patients above and below 65 years are 9,000 Pounds and 23,000 Pounds, respectively. CT scanning appears cost-effective in dementia patients under 65 years. It should be undertaken selectively in more elderly patients. Surgical treatment of normal pressure hydrocephalus may reduce quality adjusted survival and should only be undertaken within clinical trials.

Age Factors, Aged, Aged, 80 and over, Cost-Benefit Analysis, Dementia/diagnostic imaging, Humans, Incidence, Mass Screening/economics, Middle Aged, Models, Econometric, Patient Selection, Prevalence, Quality-Adjusted Life Years, Scotland/epidemiology, State Medicine/economics, Survival Analysis, Tomography, X-Ray Computed/economics, Treatment Outcome
0266-4623
406-423
Foster, G R
101c49f9-c99c-4c49-bb39-7298552d5bfa
Scott, D A
19b5fd34-9974-4ae4-8be0-27a693639e20
Payne, S
8e121d5e-3417-415c-8319-71cecacc7b98
Foster, G R
101c49f9-c99c-4c49-bb39-7298552d5bfa
Scott, D A
19b5fd34-9974-4ae4-8be0-27a693639e20
Payne, S
8e121d5e-3417-415c-8319-71cecacc7b98

Foster, G R, Scott, D A and Payne, S (1999) The use of CT scanning in dementia: A systematic review. International Journal of Technology Assessment in Health Care, 15 (2), 406-423.

Record type: Review

Abstract

While reversible cases of dementia are rare once detected, the patient may benefit from treatment. This paper examines the cost-effectiveness of computerized tomography (CT) scanning as a screening test for potentially reversible dementia. A systematic review was carried out to identify the proportion of patients with dementia above and below the age of 65 years with a theoretically treatable condition and the proportion of these patients who would benefit from neurosurgery. Information was combined with epidemiological and financial data relating to Scotland to model the costs and benefits of implementing a national screening program. Subdural hematoma, normal pressure hydrocephalus, and brain tumours are rare conditions treatable by neurosurgery. A scanning and treatment program for Scotland would cost 4.6 million Pounds per annum. Of 531 reversible cases detected, 136 would benefit from neurosurgery, 369 would not benefit, and 26 would die as a result of surgery. Treating normal pressure hydrocephalus reduces overall quality-adjusted survival. The most cost effective screening strategy is to scan all patients but treat only subdural hematomas, gaining 178 quality-adjusted life-years (QALYs) at a cost of 14,171 Pounds per QALY for patients aged 65 at the time of the scan. The corresponding figures for patients above and below 65 years are 9,000 Pounds and 23,000 Pounds, respectively. CT scanning appears cost-effective in dementia patients under 65 years. It should be undertaken selectively in more elderly patients. Surgical treatment of normal pressure hydrocephalus may reduce quality adjusted survival and should only be undertaken within clinical trials.

Full text not available from this repository.

More information

Published date: 1999
Keywords: Age Factors, Aged, Aged, 80 and over, Cost-Benefit Analysis, Dementia/diagnostic imaging, Humans, Incidence, Mass Screening/economics, Middle Aged, Models, Econometric, Patient Selection, Prevalence, Quality-Adjusted Life Years, Scotland/epidemiology, State Medicine/economics, Survival Analysis, Tomography, X-Ray Computed/economics, Treatment Outcome

Identifiers

Local EPrints ID: 441360
URI: http://eprints.soton.ac.uk/id/eprint/441360
ISSN: 0266-4623
PURE UUID: 1e4c1c8d-0a39-4d02-8f16-93f08689bcc6
ORCID for D A Scott: ORCID iD orcid.org/0000-0001-6475-8046

Catalogue record

Date deposited: 10 Jun 2020 16:31
Last modified: 12 Jun 2020 00:47

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Contributors

Author: G R Foster
Author: D A Scott ORCID iD
Author: S Payne

University divisions

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