Thavorn K, Wang Z, Fergusson D, van Katwyk S, Arnaout A, Clemons M
Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON;; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON;; Institute for Clinical Evaluative Sciences, Toronto, ON;
Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON;; Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON;
Curr Oncol. 2016 Feb;23(Suppl 1):S52-5. doi: 10.3747/co.23.2977. Epub 2016 Feb 29.
Despite the publication of multiple evidence-based guidelines recommending against routine imaging for distant metastasis in patients with early-stage (i/ii) breast cancer, such imaging is frequently performed. The present retrospective cohort study was conducted to estimate the cost of unnecessary imaging tests in women with stage i and ii breast cancer diagnosed between 1 January 2007 and 31 December 2012 in Ontario.
We obtained patient-level demographic and tumour data from a large provincial dataset. The total cost of unwarranted imaging tests (in 2015 Canadian dollars) was considered to be equal to the sum of imaging costs incurred between 2007 and 2012 and was stratified by disease stage, imaging modality, and body site.
Of the 26,547 identified patients with early-stage breast cancer, 22,811 (85.9%) underwent at least 1 imaging test, with an average of 3.7 tests per patient (3.2 for stage i patients and 4.0 for stage ii patients) over 5 years. At least 1 imaging test was performed in 79.6% of stage i and 92.7% of stage ii patients. During a 5-year period, the cost of unwarranted imaging in patients with early-stage breast cancer ranged from CA$4,418,139 to CA$6,865,856, depending on guideline recommendations.
Our study highlights the substantial cost of excess imaging that could be saved and re-allocated to patient care if evidence-based guidelines are followed. Future studies should assess strategies to ensure that evidence-based guidelines are followed and to increase awareness of the cost implications of nonadherence to guidelines.
尽管已发布多项循证指南，建议不要对早期（I/II期）乳腺癌患者进行常规的远处转移成像检查，但此类成像检查仍经常进行。本回顾性队列研究旨在估算2007年1月1日至2012年12月31日期间在安大略省诊断为I期和II期乳腺癌的女性中，不必要的成像检查的费用。
我们从一个大型省级数据集中获取了患者层面的人口统计学和肿瘤数据。无必要的成像检查的总费用（以2015年加拿大元计）被认为等于2007年至2012年期间产生的成像费用总和，并按疾病阶段、成像方式和身体部位进行分层。
在26547名确诊的早期乳腺癌患者中，22811名（85.9%）接受了至少1次成像检查，5年期间每位患者平均进行3.7次检查（I期患者为3.2次，II期患者为4.0次）。I期患者中有79.6%、II期患者中有92.7%至少进行了1次成像检查。在5年期间，根据指南建议，早期乳腺癌患者无必要成像检查的费用在4418139加元至6865856加元之间。
我们的研究强调了过度成像检查产生的巨大费用，如果遵循循证指南，这些费用可以节省下来并重新分配用于患者护理。未来的研究应评估确保遵循循证指南以及提高对不遵守指南所产生费用影响的认识的策略。
