1 Department of Radiology, Thomas Jefferson University, 132 S 10th St, Ste 1089, Philadelphia, PA 19107.
AJR Am J Roentgenol. 2014 Jan;202(1):124-35. doi: 10.2214/AJR.12.9642.
The costs of an ultrasound-CT protocol and a CT-only protocol for an appendicitis evaluation are compared. For the ultrasound-CT protocol, patients with right lower quadrant abdominal pain undergo an ultrasound examination. If it is positive for appendicitis, they are sent directly to surgery, avoiding CT.
A comparative effectiveness research study was conducted. The costs of imaging tests, excess surgeries, and excess surgical deaths for the ultrasound-CT protocol and the costs of imaging tests and excess cancer deaths in the CT-only protocol were estimated. Data sources were Centers for Medicare & Medicaid Services (CMS) datasets, national hospital discharge surveys, radiology information system cases, and U.S. Census Bureau life tables. A meta-analysis and sensitivity analyses were also conducted.
The meta-analysis showed a positive predictive value of 92.5% for CT and 91.0% for ultrasound. Analysis of CMS files showed that utilization of CT was almost exactly 2.0 examinations (one abdominal and one pelvic) per patient and for ultrasound was almost nil. The cost of this imaging protocol was $547 per patient, whereas the cost of a limited ultrasound study would be $88 per patient. For the total U.S. population, the cost savings in imaging minus the cost of extra surgeries and extra surgical deaths is $24.9 million per year. Following model VII proposed by the Committee on the Biological Effects of Ionizing Radiation (BEIR), which is known as "BEIR VII," the avoidance of a 12.4-mSv exposure for 262,500 persons would prevent 180 excess cancer deaths. The value of the years of life lost would be $339.5 million. The sensitivity analyses indicate that the cost savings are robust.
An ultrasound-CT protocol for appendicitis evaluation offers potentially large savings over the standard CT-only protocol. There are moderate savings from using a less expensive imaging technique despite extra surgeries and large savings from radiation exposure avoided.
比较超声 CT 方案和 CT 单方案在阑尾炎评估中的成本。对于超声 CT 方案，右下腹痛患者先进行超声检查。如果超声检查提示阑尾炎阳性，则直接转至外科手术，避免 CT 检查。
进行了一项比较有效性研究。对超声 CT 方案的影像学检查、过度手术和过度手术死亡的成本，以及 CT 单方案的影像学检查和过度癌症死亡的成本进行了估算。数据来源包括医疗保险和医疗补助服务中心（CMS）数据集、国家医院出院调查、放射信息系统病例以及美国人口普查局生命表。还进行了荟萃分析和敏感性分析。
荟萃分析显示 CT 的阳性预测值为 92.5%，超声的阳性预测值为 91.0%。对 CMS 文件的分析表明，CT 的利用率几乎恰好是每位患者 2 次检查（一次腹部检查和一次盆腔检查），而超声几乎为零。该影像学方案的成本为每位患者 547 美元，而有限的超声检查每位患者的成本为 88 美元。对于美国总人口，减去额外手术和额外手术死亡的影像学成本节省为每年 2490 万美元。根据电离辐射生物效应委员会（BEIR）提出的第七版模型（简称“BEIR VII”），为 262500 人避免 12.4mSv 的照射可预防 180 例额外癌症死亡。失去的生命年价值为 3.395 亿美元。敏感性分析表明，成本节约是稳健的。
与标准 CT 单方案相比，超声 CT 方案在阑尾炎评估中具有潜在的巨大节省。尽管需要进行更多的手术，但使用成本较低的影像学技术可以节省中等成本，并且避免辐射暴露可节省大量成本。
