Larcos G, Chi K K, Shiell A, Berry G
University of Sydney and Department of Nuclear Medicine and Ultrasound, Westmead Hospital, NSW.
Aust N Z J Med. 2000 Apr;30(2):195-201. doi: 10.1111/j.1445-5994.2000.tb00807.x.
There is a controversy regarding the investigation of patients with suspected acute pulmonary embolism (PE).
To compare the cost-effectiveness of alternative methods of diagnosing acute PE. Chest helical computed tomography (CT) alone and in combination with venous ultrasound (US) of legs and pulmonary angiography (PA) were compared to a conventional algorithm using ventilation-perfusion (V/Q) scintigraphy supplemented in selected cases by US and PA.
A decision-analytical model was constructed to model the costs and effects of the three diagnostic strategies in a hypothetical cohort of 1000 patients each. Transition probabilities were based on published data. Life years gained by each strategy were estimated from published mortality rates. Schedule fees were used to estimate costs.
The V/Q protocol is both more expensive and more effective than CT alone resulting in 20.1 additional lives saved at a (discounted) cost of $940 per life year gained. An additional 2.5 lives can be saved if CT replaces V/Q scintigraphy in the diagnostic algorithm but at a cost of $23,905 per life year saved.
The more effective diagnostic strategies are also more expensive. In patients with suspected PE, the incremental cost-effectiveness of the V/Q based strategy over CT alone is reasonable in comparison with other health interventions. The cost-effectiveness of the supplemented CT strategy is more questionable.
对于疑似急性肺栓塞（PE）患者的检查存在争议。
比较诊断急性肺栓塞的不同方法的成本效益。将单独的胸部螺旋计算机断层扫描（CT）、联合腿部静脉超声（US）和肺血管造影（PA）与使用通气灌注（V/Q）闪烁扫描并在选定病例中辅以US和PA的传统算法进行比较。
构建一个决策分析模型，对每组1000名患者的三种诊断策略的成本和效果进行建模。转移概率基于已发表的数据。根据已发表的死亡率估计每种策略获得的生命年。使用收费标准来估计成本。
V/Q方案比单独使用CT更昂贵且更有效，每获得一个生命年可额外挽救20.1条生命，（贴现）成本为940美元。如果在诊断算法中用CT替代V/Q闪烁扫描，可额外挽救2.5条生命，但每挽救一个生命年的成本为23,905美元。
更有效的诊断策略也更昂贵。在疑似PE患者中，与其他健康干预措施相比，基于V/Q的策略相对于单独使用CT的增量成本效益是合理的。补充CT策略的成本效益更值得怀疑。
