Keen J D, Keen R R
Department of Radiology, Cook County Hospital, 1835 West Harrison Street, Chicago, IL 60612-9985, USA.
Cardiovasc Surg. 2001 Oct;9(5):441-7. doi: 10.1016/s0967-2109(01)00022-9.
The purpose of this study was to apply decision analysis to an established practice in vascular trauma diagnosis. While exclusion arteriography has resulted in an increase in positive surgical explorations, no formal analysis that determined either the cost-effectiveness of exclusion arteriography or the cost-effectiveness ratio has been reported in the literature. We created a decision model that compared exclusion arteriography and surgical exploration, the standard used prior to the development of extremity arteriography. The decision model used predominantly literature derived estimates for the prevalence of arterial injuries and the accuracy, complications, outcomes and costs of both arteriography and exploration. Exclusion arteriography is cost-effective. This finding is robust to changes in the major model variables. Compared to surgical exploration, exclusion arteriography is a superior strategy by dominance (more effective and costs less). Therefore, a cost-effectiveness ratio cannot be calculated. Under the base case assumption of 28% prevalence of arterial injury requiring operation, exclusion arteriography saves about $2000 and adds 0.3 quality adjusted life years (QALY) for each patient. Decision analysis can be successfully applied to problems in vascular trauma diagnosis.
本研究的目的是将决策分析应用于血管创伤诊断的既定实践中。虽然排除性动脉造影已导致阳性手术探查率增加，但文献中尚未报道确定排除性动脉造影的成本效益或成本效益比的正式分析。我们创建了一个决策模型，将排除性动脉造影与手术探查进行比较，手术探查是肢体动脉造影发展之前使用的标准方法。该决策模型主要使用从文献中得出的动脉损伤患病率估计值，以及动脉造影和探查的准确性、并发症、结果及成本。排除性动脉造影具有成本效益。这一发现对于主要模型变量的变化具有稳健性。与手术探查相比，排除性动脉造影是一种占优的更优策略（更有效且成本更低）。因此，无法计算成本效益比。在需要手术的动脉损伤患病率为28%的基础病例假设下，排除性动脉造影为每位患者节省约2000美元，并增加0.3个质量调整生命年（QALY）。决策分析可成功应用于血管创伤诊断问题。
