Romero Javier, Sanabria Alvaro, Angarita Miguel, Varón Juan Carlos
Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, D.C, Colombia.
Biomedica. 2008 Mar;28(1):139-47.
Diagnosis of acute appendicitis is difficult in nearly 30% of patients with pain in low right quadrant. Diagnostic imaging may provide a means of a more accurate diagnosis.
The cost-effectiveness of diagnostic image tests was calculated for comparison with routine physical examination in patients with abdominal pain suspected to be appendicitis.
A cost-effectiveness protocol was designed, using a decision analysis model. The standard case was a patient with abdominal pain in right lower quadrant and suspicion of appendicitis. Three independent diagnostic alternatives were selected--ultrasonography, abdominal tomography and physical exam in hospital with the subject under observation less than six hours. Operative characteristics, study design and costs of interventions and outcomes were assessed. The main outcome consisted of a confirmed diagnosis of appendicitis. The point of view taken was that of health maintenance organizations. Direct and indirect medical costs were measured. Time horizon used was three months. A one way sensitivity analysis was made.
For a prepaid system, the most cost-effective strategy was abdominal tomography, with a cost-effectiveness ratio of US$965/diagnosed patient. For public system, the most cost-effective strategy was abdominal tomography, with a cost-effectiveness ratio of US$492/diagnosed patient.
Imaging diagnostic methods, in cases of abdominal pain suspected to be appendicitis, are more cost-effective than physical exam to make accurate diagnostic decisions. Tomography offers the best cost-effectiveness in prepaid system and in public health system.
在近30%的右下腹疼痛患者中，急性阑尾炎的诊断存在困难。诊断性影像学检查可能提供一种更准确诊断的方法。
计算诊断性影像检查的成本效益，以便与疑似阑尾炎腹痛患者的常规体格检查进行比较。
使用决策分析模型设计了一个成本效益方案。标准病例为右下腹疼痛且疑似阑尾炎的患者。选择了三种独立的诊断方法——超声检查、腹部断层扫描以及在医院进行体格检查且观察时间少于6小时。评估了手术特征、研究设计以及干预措施和结果的成本。主要结果包括阑尾炎确诊。所采用的观点是健康维护组织的观点。测量了直接和间接医疗成本。使用的时间范围是三个月。进行了单向敏感性分析。
对于预付费系统，最具成本效益的策略是腹部断层扫描，确诊患者的成本效益比为965美元/例。对于公共系统，最具成本效益的策略也是腹部断层扫描，确诊患者的成本效益比为492美元/例。
在疑似阑尾炎的腹痛病例中，影像诊断方法在做出准确诊断决策方面比体格检查更具成本效益。断层扫描在预付费系统和公共卫生系统中提供了最佳的成本效益。
