Keen J D, Dunne P M, Keen R R, Langer B G
Department of Radiology, Cook County Hospital, 1835 West Harrison Street, Chicago, Illinois 60612-9985, USA.
J Vasc Interv Radiol. 2001 Jul;12(7):813-21. doi: 10.1016/s1051-0443(07)61505-x.
Many urban trauma centers have abandoned proximity arteriography, which is defined as exclusion arteriography used to evaluate the asymptomatic patient with penetrating extremity trauma near major arteries. However, decision analysis has not been applied to study proximity arteriography.
The cost-effectiveness of proximity arteriography was examined by creating a decision model that compared arteriography with observation after patient examination in the trauma unit. The model used predominantly literature-derived estimates for input variables and outcomes. The authors retrospectively reviewed arteriograms for 1 year to identify major occult injuries (requiring intervention) at their institution. After a resource-based cost analysis from the taxpayers' perspective, the cost-effectiveness ratio was calculated (incremental cost per quality-adjusted life year [QALY] gained) for proximity arteriography.
For proximity trauma, arteriography is a dominant strategy (more effective and costs less) at a prevalence of major occult injury of 5.5% or more. Observation is a dominant strategy if the prevalence is from 0% to 0.5% or 2.0%, depending on arteriography complication assumptions. In between, arteriography is cost-effective, with a ratio of $12,100 per QALY at 2.5% prevalence (base case). Besides prevalence of occult injury, the model is sensitive to outcome assumptions for occult injuries.
Proximity arteriography is a cost-effective procedure if major occult injuries equal or exceed 1.0%.
许多城市创伤中心已摒弃了近端动脉造影术，近端动脉造影术被定义为用于评估靠近主要动脉的穿透性肢体创伤无症状患者的排除性动脉造影术。然而，决策分析尚未应用于近端动脉造影术的研究。
通过创建一个决策模型来检验近端动脉造影术的成本效益，该模型将创伤病房患者检查后动脉造影术与观察法进行比较。该模型主要使用源自文献的估计值作为输入变量和结果。作者回顾性分析了1年的动脉造影片，以确定其机构中主要的隐匿性损伤（需要干预）。从纳税人的角度进行基于资源的成本分析后，计算了近端动脉造影术的成本效益比（每获得一个质量调整生命年[QALY]的增量成本）。
对于近端创伤，在主要隐匿性损伤患病率为5.5%或更高时，动脉造影术是一种占优策略（更有效且成本更低）。如果患病率为0%至0.5%或2.0%，观察法是占优策略，这取决于动脉造影术并发症假设。在两者之间，动脉造影术具有成本效益，在患病率为2.5%时（基础病例），每QALY的成本效益比为12,100美元。除隐匿性损伤的患病率外，该模型对隐匿性损伤的结果假设敏感。
如果主要隐匿性损伤等于或超过1.0%，近端动脉造影术是一种具有成本效益的方法。
