内镜超声检查、磁共振胰胆管造影和内镜逆行胰胆管造影在疑似胰胆疾病患者中的成本效益分析
Cost-effectiveness of endoscopic ultrasonography, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography in patients suspected of pancreaticobiliary disease.
作者信息
Ainsworth A P, Rafaelsen S R, Wamberg P A, Pless T, Durup J, Mortensen M B
机构信息
Dept. of Surgery and Radiology, Vejle Hospital, Denmark.
出版信息
Scand J Gastroenterol. 2004 Jun;39(6):579-83. doi: 10.1080/00365520410004442.
BACKGROUND
It is not known whether initial endoscopic ultrasonography (EUS) or magnetic resonance cholangiopancreatography (MRCP) is more cost effective than endoscopic retrograde cholangiopancreatography (ERCP).
METHODS
A cost-effectiveness analysis of EUS, MRCP and ERCP was performed on 163 patients. The effectiveness of an investigation was defined as the percentage of patients with no need for further evaluation after the investigation in question had been performed. Costs were assumed from the budget-holder's point of view.
RESULTS
MRCP, EUS and ERCP had a total accuracy of 0.91, 0.93 and 0.92, respectively. Eighty-four (52%) patients needed endoscopic therapy in combination with ERCP, giving an effectiveness of MRCP, EUS, and ERCP of 0.44, 0.45 and 0.92, respectively. The cost-effectiveness of MRCP, EUS, and ERCP was 6622, 7353 and 4246 Danish Kroner (DKK) per fully investigated and treated patient (1 DKK=0.14 EUR).
CONCLUSION
Within a patient population with a probability of therapeutic ERCP in 50% of the patients, ERCP was the most cost-effective strategy.
背景
目前尚不清楚初始内镜超声检查（EUS）或磁共振胰胆管造影（MRCP）是否比内镜逆行胰胆管造影（ERCP）更具成本效益。
方法
对163例患者进行了EUS、MRCP和ERCP的成本效益分析。一项检查的有效性定义为在进行该检查后无需进一步评估的患者百分比。成本是从预算持有者的角度估算的。
结果
MRCP、EUS和ERCP的总准确率分别为0.91、0.93和0.92。84例（52%）患者需要ERCP联合内镜治疗，MRCP、EUS和ERCP的有效性分别为0.44、0.45和0.92。每位经过全面检查和治疗的患者，MRCP、EUS和ERCP的成本效益分别为6622丹麦克朗（DKK）、7353丹麦克朗和4246丹麦克朗（1 DKK = 0.14欧元）。
结论
在50%的患者有治疗性ERCP可能性的患者群体中，ERCP是最具成本效益的策略。
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