Meikle SF, Zhang X, Marine WM, Calonge BN, Hamman RF, Betz G; International Society of Technology Assessment in Health Care. Meeting.
Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 1994; Abstract No. 100.
University of Colorado Health Sciences Center, Department of Preventative Medicine & Biometrics, Denver.
OBJECTIVE: To determine if the number of diagnostic laparoscopies done on women without tubal adhesive disease could be reduced by testing for tubal disease with C. trachomatis antibody titers and HSG, either singly or together. DESIGN: Historical prospective chart review. PATIENTS: All 703 infertility patients who had C. trachomatis antibody titers done from March 2, 1988 to April 30, 1992. The final study group was comprised of 218 patients who had antibody titers, HSG, and laparoscopy. MAIN OUTCOME MEASURE: Sensitivity, negative predictive value, and false positive rate were the test characteristics of interest. Tubal disease was identified by laparoscopy. RESULTS: For HSG testing, the sensitivity was 78% and the negative predictive value was 85%. For C. trachomatis titers, the sensitivity was also 78% and the negative predictive value was 82%. Ninety-five percent confidence intervals for sensitivity and negative predictive value overlapped, indicating that there was no significant difference. However, false negative rates were the same for the two tests, but false positive rates were significantly lower for HSG and series testing. Negative titers were more useful. In our study group, if both tests were negative, tubal disease was identified on laparoscopy in only 5% of cases. CONCLUSIONS: To minimize false positive tests and thus, to minimize unnecessary laparoscopies, HSG testing either alone or combined with the C. trachomatis antibody titer as series tests yielded the lowest false positive rate. Choice of most cost effective test sequence will depend on who bears the cost, the patient for undiagnosed disease, or the system for unnecessary, costly laparoscopies. Further studies of cost-benefit using well-defined testing sequences are needed to determine if C. trachomatis antibody titers in series with HSG would be more cost-effective than HSG alone in detecting tubal disease.
Publication Types:
Keywords:
- Antibodies, Bacterial
- Antibodies, Protozoan
- Female
- Health Maintenance Organizations
- Humans
- Hysterosalpingography
- Laparoscopy
- Longitudinal Studies
- Sensitivity and Specificity
- economics
- radiography
- hsrmtgs
Other ID:
UI: 102211659
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