计算机辅助检测对CT结肠成像成本效益的影响。

Impact of computer-aided detection on the cost-effectiveness of CT colonography.

作者信息

Regge Daniele, Hassan Cesare, Pickhardt Perry J, Laghi Andrea, Zullo Angelo, Kim David H, Iafrate Franco, Morini Sergio

机构信息

Radiology Unit, Institute for Cancer Research and Treatment, Candiolo, Italy.

出版信息

Radiology. 2009 Feb;250(2):488-97. doi: 10.1148/radiol.2502080685.

DOI:10.1148/radiol.2502080685

PMID:19188317

Abstract

PURPOSE

To analyze the cost-effectiveness of adding computer-aided detection (CAD) to a computed tomographic (CT) colonography screening program and to compare it with other options of colorectal cancer (CRC) prevention.

MATERIALS AND METHODS

The cost-effectiveness of screening strategies by using CT colonography with and without CAD, flexible sigmoidoscopy (FS), and optical colonoscopy were compared by using a Markov-based computer model. In the model, a hypothetical population of 100,000 persons aged 50 years underwent colorectal screening every 10 years. Baseline sensitivities for both experienced and inexperienced readers and the incremental accuracy when adding CAD were estimated from a systematic review of the literature.

RESULTS

At baseline, the addition of CAD resulted in 9% and 2% increases in CRC prevention rates for inexperienced and experienced readers, respectively, when compared with CT colonography without CAD. Assuming a CAD cost of $50 per CT colonography, the overall program costs increased by only 3%-5%, largely because of the substantial reduction in CRC-related costs. The incremental cost-effectiveness of CT colonography with CAD compared with CT colonography without CAD was $8661 and $61,354 per life-year gained for inexperienced and experienced readers, respectively. Optical colonoscopy was not a cost-effective alternative to CT colonography with CAD performed by experienced readers, with an incremental cost-effectiveness of $498,668 per life-year gained. CT colonography with CAD for inexperienced readers was more clinically effective and cost-effective than FS. At analysis, sensitivity of CT colonography with CAD for polyps 6 mm or larger was the most meaningful variable.

CONCLUSION

The addition of CAD to CT colonography screening improves the CRC prevention rate, resulting in advantageous cost-effectiveness for screening.

SUPPLEMENTAL MATERIAL

http://radiology.rsnajnls.org/cgi/content/full/250/2/488/DC1.

摘要

目的

分析在计算机断层扫描（CT）结肠成像筛查项目中添加计算机辅助检测（CAD）的成本效益，并将其与其他预防结直肠癌（CRC）的方法进行比较。

材料与方法

使用基于马尔可夫的计算机模型比较了采用有CAD和无CAD的CT结肠成像、乙状结肠镜检查（FS）以及光学结肠镜检查的筛查策略的成本效益。在该模型中，假设10万名50岁的人群每10年进行一次结肠直肠癌筛查。通过对文献的系统回顾，估计了经验丰富和经验不足的阅片者的基线敏感度以及添加CAD后的增量准确性。

结果

在基线时，与无CAD的CT结肠成像相比，添加CAD后，经验不足和经验丰富的阅片者的CRC预防率分别提高了9%和2%。假设每次CT结肠成像的CAD成本为50美元，总体项目成本仅增加了3%-5%，这主要是由于CRC相关成本的大幅降低。与无CAD的CT结肠成像相比，有CAD的CT结肠成像对于经验不足和经验丰富的阅片者每获得一个生命年的增量成本效益分别为8661美元和61354美元。对于经验丰富的阅片者进行的有CAD的CT结肠成像，光学结肠镜检查不是一种具有成本效益的替代方法，每获得一个生命年的增量成本效益为498668美元。对于经验不足的阅片者，有CAD的CT结肠成像比FS在临床效果和成本效益方面更优。在分析中，有CAD的CT结肠成像对6毫米或更大息肉的敏感度是最有意义的变量。