Paterson D I, Schwartzman K
Division of Cardiology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada.
Chest. 2001 Jun;119(6):1791-800. doi: 10.1378/chest.119.6.1791.
To assess the cost-effectiveness of spiral CT for the diagnosis of acute pulmonary embolism.
Computer-based cost-effectiveness analysis.
Simulated cohort of 1,000 patients with suspected acute pulmonary embolism (PE), with a prevalence of 28.4%, as in the Prospective Investigation of Pulmonary Embolism Diagnosis study.
Using a decision-analysis model, seven diagnostic strategies were compared, which incorporated combinations of ventilation-perfusion (V/Q) scans, duplex ultrasound of the legs, spiral CT, and conventional pulmonary angiography.
Expected survival and cost (in Canadian dollars) at 3 months were estimated. Four of the strategies yielded poorer survival at higher cost. The three remaining strategies were as follows: (1) V/Q +/- leg ultrasound +/- spiral CT, with an expected survival of 953.4 per 1,000 patients and a cost of $1,391 per patient; (2) V/Q +/- leg ultrasound +/- pulmonary angiography (the "traditional" algorithm), with an expected survival of 953.7 per 1,000 patients and a cost of $1,416 per patient; and (3) spiral CT +/- leg ultrasound, with an expected survival of 958.2 per 1,000 patients and a cost of $1,751 per patient. The traditional algorithm was then excluded by extended dominance. The cost per additional life saved was $70,833 for spiral CT +/- leg ultrasound relative to V/Q +/- leg ultrasound +/- spiral CT.
Spiral CT can replace pulmonary angiography in patients with nondiagnostic V/Q scan and negative leg ultrasound findings. This approach is likely as effective as-and possibly less expensive than-the current algorithm for diagnosis of acute PE. When spiral CT is the initial diagnostic test, followed by leg ultrasound, expected survival improves but costs are also considerably higher. These findings were robust to variations in the assumed sensitivity and specificity of spiral CT.
评估螺旋CT诊断急性肺栓塞的成本效益。
基于计算机的成本效益分析。
模拟队列中有1000例疑似急性肺栓塞（PE）患者，患病率为28.4%，如同肺栓塞诊断前瞻性研究中的情况。
使用决策分析模型，比较了七种诊断策略，这些策略包括通气-灌注（V/Q）扫描、腿部双功超声、螺旋CT和传统肺血管造影的组合。
估计了3个月时的预期生存率和成本（以加元计）。其中四种策略在成本较高的情况下生存率较低。其余三种策略如下：（1）V/Q±腿部超声±螺旋CT，每1000例患者的预期生存率为953.4，每位患者的成本为1391加元；（2）V/Q±腿部超声±肺血管造影（“传统”算法），每1000例患者的预期生存率为953.7，每位患者的成本为1416加元；（3）螺旋CT±腿部超声，每1000例患者的预期生存率为958.2，每位患者的成本为1751加元。然后通过扩展优势排除了传统算法。相对于V/Q±腿部超声±螺旋CT，螺旋CT±腿部超声每多挽救一条生命的成本为70833加元。
对于V/Q扫描未明确诊断且腿部超声检查结果为阴性的患者，螺旋CT可替代肺血管造影。这种方法可能与当前诊断急性PE的算法一样有效，且成本可能更低。当螺旋CT作为初始诊断测试，随后进行腿部超声检查时，预期生存率提高，但成本也显著更高。这些发现对于螺旋CT假定的敏感性和特异性的变化具有稳健性。
