This Article Full Text Full Text (PDF) Supplemental Data Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sawka, A. M. Articles by Young, W. F. Search for Related Content PubMed PubMed Citation Articles by Sawka, A. M. Articles by Young, W. F., Jr.

The Economic Implications of Three Biochemical Screening Algorithms for Pheochromocytoma

Division of Endocrinology, Metabolism, Nutrition, and Internal Medicine (W.F.Y.), Mayo Clinic, Rochester, Minnesota 55905; Department of Internal Medicine and Division of Endocrinology (A.M.S.), St. Joseph’s Healthcare, Hamilton, Ontario, Canada L8N 4A6; Department of Internal Medicine and Division of Endocrinology (A.M.S.), McMaster University, Hamilton, Ontario, Canada L8N 3Z5; Centre for Evaluation of Medicines (L.T.), St. Joseph’s Healthcare, Hamilton, Ontario, Canada L8N 1G6; and Department of Clinical Epidemiology and Biostatistics (L.T., A.G.), McMaster University, Hamilton, Ontario, Canada L8N 3Z5

Address all correspondence and requests for reprints to: Dr. William F. Young, Jr., Division of Endocrinology, Metabolism, Nutrition, and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.

Pheochromocytoma is a rare, life-threatening condition. Using a modeling technique, we studied the economic implications of detection strategies for pheochromocytoma (third-party payer perspective). The diagnostic efficacy of biochemical tests was based on Mayo Clinic Rochester data. In all hypothetical algorithms, positive biochemical tests were followed by abdominal computerized tomography and, if negative, metaiodobenzylguanidine scintigraphy.

In each hypothetical algorithm, imaging would be indicated after positive biochemical testing as follows: algorithm A, fractionated plasma metanephrine measurements above the laboratory reference range; or algorithm B, abnormal measurements of 24-h urinary total metanephrines or catecholamines. In algorithm C, subjects with fractions of plasma metanephrine at or above 0.5 nmol/liter or normetanephrine at or above 1.80 nmol/liter would undergo imaging, whereas those with values between the reference range and these cutoffs would undergo 24-h urinary measurements (total metanephrines and fractionated catecholamines) and be imaged if positive. We determined that, if 100,000 hypertensive patients (including 500 patients with pheochromocytoma) were tested, algorithm A (measurement of fractionated plasma metanephrines alone) would detect 489 pheochromocytoma patients at a cost of 56.6 million dollars, whereas B (24-h urinary measurements) would detect 457 pheochromocytoma patients for 39.5 million dollars, and C (combination of measurements of fractionated plasma metanephrines and urines) would detect 478 patients for 28.6 million dollars. None of the screening strategies for pheochromocytoma described are affordable if implemented on a routine basis in extremely low-risk patients. However, algorithm C may be the least costly, and at a reasonable level of sensitivity, for subjects in whom the suspicion of disease is moderate.

Abbreviations: CI, Confidence interval; CT, computerized tomography; MIBG, metaiodobenzylguanidine.

This article has been cited by other articles:

				M. d'Herbomez, G. Forzy, C. Bauters, C. Tierny, P. Pigny, B. Carnaille, F. Pattou, J.-L. Wemeau, and N. Rouaix An analysis of the biochemical diagnosis of 66 pheochromocytomas Eur. J. Endocrinol., May 1, 2007; 156(5): 569 - 575. [Abstract] [Full Text] [PDF]

				S. R BORNSTEIN and A.-P. GIMENEZ-ROQUEPLO Genetic testing in pheochromocytoma: increasing importance for clinical decision making. Ann. N.Y. Acad. Sci., August 1, 2006; 1073: 94 - 103. [Abstract] [Full Text] [PDF]

				A. GROSSMAN, K. PACAK, A. SAWKA, J. W. M LENDERS, D. HARLANDER, R. T PEASTON, R. REZNEK, J. SISSON, and G. EISENHOFER Biochemical diagnosis and localization of pheochromocytoma: can we reach a consensus? Ann. N.Y. Acad. Sci., August 1, 2006; 1073: 332 - 347. [Abstract] [Full Text] [PDF]