Huppertz A, Schmidt M, Wagner M, Puettcher O, Asbach P, Strassburg J, Stöckmann F, Schöffski O, Maurer M H
Department of Radiology, Charité Campus Mitte, Berlin.
Rofo. 2010 Sep;182(9):793-802. doi: 10.1055/s-0029-1245463. Epub 2010 Jun 1.
To compare the direct costs of two diagnostic algorithms for pretherapeutic TNM staging of rectal cancer.
In a study including 33 patients (mean age: 62.5 years), the direct fixed and variable costs of a sequential multimodal algorithm (rectoscopy, endoscopic and abdominal ultrasound, chest X-ray, thoracic/abdominal CT in the case of positive findings in abdominal ultrasound or chest X-ray) were compared to those of a novel algorithm of rectoscopy followed by MRI using a whole-body scanner. MRI included T 2w sequences of the rectum, 3D T 1w sequences of the liver and chest after bolus injection of gadoxetic acid, and delayed phases of the liver. The personnel work times, material items, and work processes were tracked to the nearest minute by interviewing those responsible for the process (surgeon, gastroenterologist, two radiologists). The costs of labor and materials were determined from personnel reimbursement data and hospital accounting records. Fixed costs were determined from vendor pricing.
The mean MRI time was 55 min. CT was performed in 19/33 patients (57%) causing an additional day of hospitalization (costs 374 euro). The costs for equipment and material were higher for MRI compared to sequential algorithm (equipment 116 vs. 30 euro; material 159 vs. 60 euro per patient). The personnel costs were markedly lower for MRI (436 vs. 732 euro per patient). Altogether, the absolute cost advantage of MRI was 31.3% (711 vs. 1035 euro for sequential algorithm).
Substantial savings are achievable with the use of whole-body MRI for the preoperative TNM staging of patients with rectal cancer.
比较两种用于直肠癌治疗前TNM分期的诊断算法的直接成本。
在一项纳入33例患者（平均年龄：62.5岁）的研究中，将序贯多模式算法（直肠镜检查、内镜和腹部超声、胸部X线检查，若腹部超声或胸部X线检查结果为阳性则进行胸部/腹部CT检查）的直接固定成本和可变成本与一种新算法（直肠镜检查后使用全身扫描仪进行MRI检查）的成本进行比较。MRI包括直肠的T2加权序列、注射钆塞酸二钠后肝脏和胸部的3D T1加权序列以及肝脏的延迟期。通过询问负责该过程的人员（外科医生、胃肠病学家、两位放射科医生），将人员工作时间、材料项目和工作流程精确到分钟进行跟踪。人工和材料成本根据人员报销数据和医院会计记录确定。固定成本根据供应商定价确定。
MRI平均时间为55分钟。19/33例患者（57%）进行了CT检查，导致额外住院一天（费用374欧元）。与序贯算法相比，MRI的设备和材料成本更高（设备：116欧元对30欧元；材料：每位患者159欧元对60欧元）。MRI的人员成本明显更低（每位患者436欧元对732欧元）。总体而言，MRI的绝对成本优势为31.3%（序贯算法为1035欧元，MRI为711欧元）。
使用全身MRI进行直肠癌患者术前TNM分期可实现大幅成本节约。
