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伴有中度冠心病预测值患者中双源 CT 与有创性冠状动脉造影的直接成本和成本效益。

Direct costs and cost-effectiveness of dual-source computed tomography and invasive coronary angiography in patients with an intermediate pretest likelihood for coronary artery disease.

机构信息

Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13553 Berlin, Germany.

出版信息

Heart. 2012 Mar;98(6):460-7. doi: 10.1136/heartjnl-2011-300149. Epub 2011 Aug 16.

Abstract

AIMS

The study aims to determine the direct costs and comparative cost-effectiveness of latest-generation dual-source computed tomography (DSCT) and invasive coronary angiography for diagnosing coronary artery disease (CAD) in patients suspected of having this disease.

METHODS

The study was based on a previously elaborated cohort with an intermediate pretest likelihood for CAD and on complementary clinical data. Cost calculations were based on a detailed analysis of direct costs, and generally accepted accounting principles were applied. Based on Bayes' theorem, a mathematical model was used to compare the cost-effectiveness of both diagnostic approaches. Total costs included direct costs, induced costs and costs of complications. Effectiveness was defined as the ability of a diagnostic test to accurately identify a patient with CAD.

RESULTS

Direct costs amounted to €98.60 for DSCT and to €317.75 for invasive coronary angiography. Analysis of model calculations indicated that cost-effectiveness grew hyperbolically with increasing prevalence of CAD. Given the prevalence of CAD in the study cohort (24%), DSCT was found to be more cost-effective than invasive coronary angiography (€970 vs €1354 for one patient correctly diagnosed as having CAD). At a disease prevalence of 49%, DSCT and invasive angiography were equally effective with costs of €633. Above a threshold value of disease prevalence of 55%, proceeding directly to invasive coronary angiography was more cost-effective than DSCT.

CONCLUSIONS

With proper patient selection and consideration of disease prevalence, DSCT coronary angiography is cost-effective for diagnosing CAD in patients with an intermediate pretest likelihood for it. However, the range of eligible patients may be smaller than previously reported.

摘要

目的

本研究旨在确定用于诊断疑似患有冠状动脉疾病(CAD)患者的最新一代双源计算机断层扫描(DSCT)和有创性冠状动脉造影的直接成本和比较成本效益。

方法

该研究基于先前详细阐述的具有中等 CAD 术前可能性的队列和补充的临床数据。成本计算基于对直接成本的详细分析,并应用了普遍接受的会计原则。基于贝叶斯定理,使用数学模型比较了两种诊断方法的成本效益。总费用包括直接费用、诱导费用和并发症费用。有效性被定义为诊断测试准确识别 CAD 患者的能力。

结果

DSCT 的直接成本为 98.60 欧元,有创性冠状动脉造影的直接成本为 317.75 欧元。模型计算分析表明,成本效益随着 CAD 患病率的增加呈双曲线增长。鉴于研究队列中 CAD 的患病率(24%),DSCT 比有创性冠状动脉造影更具成本效益(正确诊断为 CAD 的每位患者的费用为 970 欧元比 1354 欧元)。在 CAD 患病率为 49%的情况下,DSCT 和有创性血管造影具有相同的成本效益,费用为 633 欧元。在疾病患病率超过阈值 55%的情况下,直接进行有创性冠状动脉造影比 DSCT 更具成本效益。

结论

通过适当的患者选择和考虑疾病的流行程度,DSCT 冠状动脉造影在诊断具有中等术前 CAD 可能性的患者的 CAD 方面具有成本效益。然而,合格患者的范围可能比以前报告的要小。

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