Lehtimäki Tiina T, Valtonen Hannu, Miettinen Pekka, Juvonen Petri, Paajanen Hannu, Vanninen Ritva
Department of Clinical Radiology, Kuopio University Hospital, Puijonlaaksontie 2, FI-70210, Kuopio, Finland.
University of Eastern Finland, Department of Health and Social Management, Yliopistonranta 1, FI-70211 Kuopio, Finland.
Eur J Radiol. 2017 Feb;87:1-7. doi: 10.1016/j.ejrad.2016.11.031. Epub 2016 Nov 28.
To evaluate the impact of patient age on hospital resource use and treatment costs of acute abdominal pain (AAP).
A total of 300 adult patients with AAP were randomised to either computed tomography (CT, n=150) or selective imaging practice (SIP, n=150) groups. Final analysis included 254 patients, 143 (42 patients ≥65years) in the CT and 111 (32 patients ≥65years) in the SIP group. All CT group patients underwent abdominal CT whereas in the SIP group, imaging was based on the clinical assessment. For each patient, the hospital length of stay (LOS), the numbers and costs of diagnostic and treatment procedures arising from AAP were calculated and registered. The incremental cost-effectiveness ratio (ICER) and bootstrapped cost-effectiveness acceptability curve (CEAC) were estimated for routine CT.
Treatment costs, imaging costs and LOS increased in conjunction with aging in both study groups, and were generally higher in the CT group compared to the SIP group. In the SIP group, CT was undertaken in 34% (27/79) of the <65year olds but in 59% (19/32) of the older patients (≥65years) (p=0.02). The proportion of patients with non-specific abdominal pain was significantly lower in patients ≥65years than in their younger counterparts (p=0.04). In the routine CT group, the ICER of obtaining a specific diagnosis was 1682 € for patients <65years and 1055 € for patients ≥65years. According to CEAC estimation, routine CT for every patient with AAP has a 95% probability of being cost-effective if society is willing to pay 14087 € for an additional specific diagnosis for patients <65 years but only 4204 € in those ≥65years.
Treatment costs of AAP increase in parallel with aging, and the costs are generally higher with routine CT compared to selective imaging. The probability of obtaining a specific diagnosis of AAP increases with aging. If obtaining a specific diagnosis is deemed crucial, then routine CT is more cost-effective in patients over 65 years compared to younger patients. Considering the diagnostic challenges of AAP in the elderly, liberal CT use can be advocated in this patient group.
评估患者年龄对急性腹痛（AAP）住院资源利用和治疗费用的影响。
总共300例成年AAP患者被随机分为计算机断层扫描（CT，n = 150）组或选择性影像检查（SIP，n = 150）组。最终分析纳入254例患者，CT组143例（42例年龄≥65岁），SIP组111例（32例年龄≥65岁）。CT组所有患者均接受腹部CT检查，而SIP组的影像检查则基于临床评估。计算并记录每位患者的住院时间（LOS）、因AAP产生的诊断和治疗程序的数量及费用。估算常规CT的增量成本效益比（ICER）和自展成本效益可接受性曲线（CEAC）。
两个研究组的治疗费用、影像检查费用和住院时间均随年龄增长而增加，且CT组总体上高于SIP组。在SIP组中，65岁以下患者中有34%（27/79）接受了CT检查，而65岁及以上老年患者中这一比例为59%（19/32）（p = 0.02）。65岁及以上患者中非特异性腹痛患者的比例显著低于年轻患者（p = 0.04）。在常规CT组中，65岁以下患者获得明确诊断的ICER为1682欧元，65岁及以上患者为则1055欧元。根据CEAC估算，如果社会愿意为65岁以下患者额外获得明确诊断支付14087欧元，而为65岁及以上患者支付4204欧元，那么对每位AAP患者进行常规CT检查有95%的概率具有成本效益。
AAP的治疗费用随年龄增长而增加，但常规CT检查的费用总体上高于选择性影像检查。获得AAP明确诊断的概率随年龄增长而增加。如果认为获得明确诊断至关重要，那么与年轻患者相比，常规CT检查在65岁以上患者中更具成本效益。鉴于老年患者AAP的诊断挑战，可提倡在该患者群体中更广泛地使用CT检查。
