Szczepura A K, Fletcher J, Fitz-Patrick J D
Health Services Research Unit, Warwick Business School Research Bureau, University of Warwick, Coventry.
BMJ. 1991 Dec 7;303(6815):1435-9. doi: 10.1136/bmj.303.6815.1435.
To measure, in a service setting, the effect of magnetic resonance imaging on diagnosis, diagnostic certainty, and patient management in the neurosciences; to measure the cost per patient scanned; to estimate the marginal cost of imaging and compare this with its diagnostic impact; to measure changes in patients' quality of life; and to record the diagnostic pathway leading to magnetic resonance imaging.
Controlled observational study using questionnaires on diagnosis and patient management before and after imaging. Detailed costing study. Quality of life questionnaires at the time of imaging and six months later. Diagnostic pathways extracted from medical records for a representative sample.
Regional superconducting 1.5 T magnetic resonance service.
782 consecutive neuroscience patients referred by consultants for magnetic resonance imaging during June 1988-9; diagnostic pathways recorded for 158 cases.
Costs of magnetic resonance imaging and preliminary investigations; changes in planned management and resulting savings; changes in principal diagnosis and diagnostic certainty; changes in patients' quality of life.
Average cost of magnetic resonance imaging was estimated at 206.20/patient pounds (throughput 2250 patients/year, 1989-90 prices including contrast and upgrading). Before magnetic resonance imaging diagnostic procedures cost 164.40/patient pounds (including inpatient stays). Management changed after imaging in 208 (27%) cases; saving an estimated 80.90/patient pounds. Confidence in planned management increased in a further 226 (29%) referrals. Consultants' principal diagnosis changed in 159 of 782 (20%) referrals; marginal cost per diagnostic change was 626 pounds. Confidence in diagnosis increased in 236 (30%) referrals. No improvement in patients' quality of life at six month assessment.
Any improvement in diagnosis with magnetic resonance imaging is achieved at a higher cost. Techniques for monitoring the cost effectiveness of this technology need to be developed.
在服务环境中，评估磁共振成像对神经科学领域诊断、诊断确定性及患者管理的影响；测定每位接受扫描患者的费用；估算成像的边际成本并将其与诊断影响相比较；评估患者生活质量的变化；记录导致进行磁共振成像的诊断流程。
采用成像前后关于诊断和患者管理的问卷进行对照观察研究。详细成本核算研究。在成像时及六个月后进行生活质量问卷调查。从病历中提取具有代表性样本的诊断流程。
区域超导1.5T磁共振服务机构。
1988年6月至1989年期间由顾问转诊进行磁共振成像的782例连续神经科学患者；记录了158例患者的诊断流程。
磁共振成像及初步检查的费用；计划管理的变化及由此产生的节省费用；主要诊断及诊断确定性的变化；患者生活质量的变化。
磁共振成像的平均费用估计为每位患者206.20英镑（1989 - 1990年价格，含造影剂和升级费用，年吞吐量2250例患者）。在进行磁共振成像前，诊断程序的费用为每位患者164.40英镑（包括住院费用）。成像后，208例（27%）患者的管理发生了变化；估计每位患者节省80.90英镑。另有226例（29%）转诊患者对计划管理的信心有所增加。在782例转诊患者中，159例（20%）顾问的主要诊断发生了变化；每次诊断变化的边际成本为626英镑。236例（30%）转诊患者对诊断的信心有所增加。六个月评估时患者生活质量无改善。
磁共振成像在诊断方面的任何改善都是以更高的成本实现的。需要开发监测该技术成本效益的方法。
