TABLE I -.
Resource consumption estimates
| REMS Mean (SD) | DXA Mean (SD) | REMS − DXA Mean (p-value) | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Most conservative scenario (L) | Base-case scenario (M) | Least conservative scenario (H) | Most conservative scenario (L) | Base-case scenario (M) | Least conservative scenario (H) | Most conservative scenario (L) | Base-case scenario (M) | Least conservative scenario (H) | |
| Time dedicated to diagnosis (in minutes) | |||||||||
| Clinician | 15.8 (10.7) | 29.0 (12.6) | 55.0 (30.9) | 16.5 (13.6) | 26.6 (18.3) | 46 (27.8) | −0.7 (n.s.) | 2.4 (n.s.) | 9.0 (n.s.) |
| Nurse | 3.5 (7.7) | 3.8 (8.9) | 6.2 (12.9) | 6.2 (9.2) | 7.6 (10) | 11 (12.9) | −2.7 (n.s.) | −3.8 (n.s.) | −4.8 (n.s.) |
| Radiology technician | 2.3 (4.8) | 4.8 (9.2) | 6.9 (13.3) | 22.6 (11.7) | 32.3 (15.6) | 48.8 (17.1) | −20.3 (<0.001) | −27.5 (<0.001) | −41.9 (<0.001) |
| Resident | 2.7 (7.3) | 6.6 (11.7) | 13.1 (26.7) | 7 (13.4) | 12.6 (19.2) | 19.5 (27.2) | −4.3 (n.s.) | −6.0 (n.s.) | −6.4 (n.s.) |
| Other healthcare personne | l0.0 (0.0) | 0.4 (1.4) | 0.8 (2.8) | 1.5 (3.4) | 3.1 (7.9) | 10 (28.2) | −1.5 (n.s.) | −2.7 (n.s.) | −9.2 (n.s.) |
| Administrative staff | 2.8 (3.8) | 4.4 (6.3) | 7.9 (8.6) | 7.7 (8.4) | 21.7 (23.4) | 57.2 (89.6) | −4.9 (n.s.) | −17.3 (0.018) | −49.3 (0.050) |
| All professionals | 27.1 (21.5) | 49.1 (22.6) | 89.9 (48.8) | 61.5 (43.0) | 103.9 (44.7) | 192.5 (110.5) | −34.4 (0.020) | −54.8 (<0.001) | −102.6 (0.007) |
| Instrumental exams (% of patients) | |||||||||
| CT scan | 1.5 (5.5) | 2.8 (6.0) | 11.0 (27.7) | 6.6 (12.4) | 11.3 (21.0) | 24.4 (38.0) | −5.1 (n.s.) | −8.5 (n.s.) | −13.4 (n.s.) |
| Magnetic resonance | 2.5 (4.3) | 4.3 (6.6) | 13.2 (27.7) | 7.0 (11.1) | 11.5 (16.2) | 24.0 (32.5) | −4.5 (n.s.) | −7.2 (n.s.) | −10.8 (n.s.) |
| X-ray of the dorsal-lumbar spine | 15.9 (24.8) | 21.5 (24.7) | 33.5 (38.0) | 22.5 (24.2) | 33.5 (24.8) | 51.0 (36.3) | −6.6 (n.s.) | −12.0 (n.s.) | −17.5 (n.s.) |
| DXA (for REMS patients)/REMS (for DXA | 33.5 (38.7) | 39.2 (40.7) | 44.6 (43.9) | 19 (20.8) | 25.5 (25.4) | 48.5 (32.7) | − | − | − |
| Laboratory tests – I level (% of patients) | |||||||||
| 24-hour urinary calcium | 28.1 (30.2) | 35.8 (32.1) | 48.8 (38.3) | 31.5 (33.0) | 39.0 (34.8) | 62.5 (36.6) | −3.4 (n.s.) | −3.2 (n.s.) | −13.7 (n.s.) |
| Alkaline phosphatase (ALP) | 34.5 (39.3) | 41.2 (40.7) | 56.0 (43.7) | 45.5 (44.7) | 52.0 (44.9) | 74.0 (40.0) | −11.0 (n.s.) | −10.8 (n.s.) | −18.0 (n.s.) |
| Calcemia | 40.9 (43.7) | 48.8 (43.0) | 61.6 (43.3) | 57.0 (49.5) | 59.0 (48.9) | 77.5 (41.3) | −16.1 (n.s.) | −10.2 (n.s.) | −15.9 (n.s.) |
| Complete blood count | 31.2 (46.2) | 35.0 (45.9) | 44.6 (47.5) | 36.0 (43.3) | 41.0 (44.6) | 61.5 (43.8) | −4.8 (n.s.) | −6.0 (n.s.) | −16.9 (n.s.) |
| Creatininemia | 37.8 (45.4) | 43.2 (45.2) | 54.1 (46.4) | 49.5 (47.9) | 54.0 (46.7) | 75.0 (40.6) | −11.7 (n.s.) | −10.8 (n.s.) | −20.9 (n.s.) |
| Erythrocyte sedimentation rate (ESR) | 27.0 (41.3) | 32.7 (41.7) | 46.9 (46.4) | 31.0 (42.3) | 36.5 (42.6) | 58.5 (44.2) | −4.0 (n.s.) | −3.8 (n.s.) | −11.6 (n.s.) |
| Phosphorus | 40.9 (43.7) | 45.3 (44.1) | 58.2 (43.6) | 47.0 (49.9) | 51.5 (47.6) | 72.5 (41.3) | −6.1 (n.s.) | −6.2 (n.s.) | −14.3 (n.s.) |
| Protidemia (fraction) | 30.9 (46.3) | 34.4 (46.0) | 46.4 (46.0) | 37.0 (44.0) | 42.0 (43.1) | 65.0 (41.7) | −6.1 (n.s.) | −7.6 (n.s.) | −18.6 (n.s.) |
| Laboratory tests – II level (% of patients) | |||||||||
| Ionized calcium | 16.3 (30.1) | 22.7 (36.4) | 34.5 (45.8) | 19.2 (32.3) | 26.0 (38.7) | 48.3 (48.6) | −2.9 (n.s.) | −3.3 (n.s.) | −13.8 (n.s.) |
| Thyroid-stimulating hormone (TSH) | 17.9 (33.0) | 22.5 (33.4) | 33.7 (40.4) | 22.4 (39.1) | 25.1 (37.7) | 44.5 (42.5) | −4.5 (n.s.) | −2.6 (n.s.) | −10.8 (n.s.) |
| Parathyroid hormone (PTH) | 30.5 (40.2) | 39.4 (40.6) | 54.5 (42.2) | 37.5 (43.8) | 45.0 (45.0) | 67.5 (43.3) | −7.0 (n.s.) | −5.6 (n.s.) | −13.0 (n.s.) |
| 25-Hydroxy vitamin D | 44.6 (42.0) | 52.7 (40.7) | 73.8 (36.2) | 48.0 (47.6) | 53.5 (46.7) | 75.5 (40.9) | −3.4 (n.s.) | −0.8 (n.s.) | −1.7 (n.s.) |
| Overnight dexamethasone suppression | 8.2 (19.5) | 11.5 (22.4) | 22.0 (34.4) | 8.7 (21.8) | 14.8 (25.9) | 53.9 (41.6) | −0.5 (n.s.) | −3.3 (n.s.) | −13.9 (n.s.) |
| Serum immunofixation | 9.0 (20.0) | 13.1 (24.2) | 22.5 (36.0) | 12.2 (27.8) | 16.9 (28.6) | 37.0 (41.0) | −3.2 (n.s.) | −3.8 (n.s.) | −14.5 (n.s.) |
| Urine immunofixation | 6.6 (16.3) | 9.8 (19.1) | 19.2 (32.8) | 7.2 (15.4) | 11.9 (18.0) | 33.0 (38.0) | −0.6 (n.s.) | −2.1 (n.s.) | −13.8 (n.s.) |
| Anti-transglutaminase antibodies (ATA) | 14.4 (30.4) | 18.5 (31.2) | 29.1 (38.4) | 16.7 (33.1) | 19.4 (32.0) | 39.5 (41.5) | −2.3 (n.s.) | −0.9 (n.s.) | −10.4 (n.s.) |
Since the p-value is also affected by the sample size (the smaller the sample size, the higher the p-value), we should be careful in interpreting the lack of statistical significance of the difference in estimates (as it may be partly driven by the low number of observations).
CT = computed tomography; DXA = dual-energy X-ray absorptiometry; n.s. = not significant; REMS = Radiofrequency Echographic Multi Spectrometry; SD = standard deviation.