Kip Michelle Ma, Schop Annemarie, Stouten Karlijn, Dekker Soraya, Dinant Geert-Jan, Koffijberg Hendrik, Bindels Patrick Je, IJzerman Maarten J, Levin Mark-David, Kusters Ron
1 Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands.
2 Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands.
Ann Clin Biochem. 2018 Nov;55(6):630-638. doi: 10.1177/0004563217748984. Epub 2018 Feb 1.
Background Establishing the underlying cause of anaemia in general practice is a diagnostic challenge. Currently, general practitioners individually determine which laboratory tests to request (routine work-up) in order to diagnose the underlying cause. However, an extensive work-up (consisting of 14 tests) increases the proportion of patients correctly diagnosed. This study investigates the cost-effectiveness of this extensive work-up. Methods A decision-analytic model was developed, incorporating all societal costs from the moment a patient presents to a general practitioner with symptoms suggestive of anaemia (aged ≥ 50 years), until the patient was (correctly) diagnosed and treated in primary care, or referred to (and diagnosed in) secondary care. Model inputs were derived from an online survey among general practitioners, expert estimates and published data. The primary outcome measure was expressed as incremental cost per additional patient diagnosed with the correct underlying cause of anaemia in either work-up. Results The probability of general practitioners diagnosing the correct underlying cause increased from 49.6% (95% CI: 44.8% to 54.5%) in the routine work-up to 56.0% (95% CI: 51.2% to 60.8%) in the extensive work-up (i.e. +6.4% [95% CI: -0.6% to 13.1%]). Costs are expected to increase slightly from €842/patient (95% CI: €704 to €994) to €845/patient (95% CI: €711 to €994), i.e. +€3/patient (95% CI: €-35 to €40) in the extensive work-up, indicating incremental costs of €43 per additional patient correctly diagnosed. Conclusions The extensive laboratory work-up is more effective for diagnosing the underlying cause of anaemia by general practitioners, at a minimal increase in costs. As accompanying benefits in terms of quality of life and reduced productivity losses could not be captured in this analysis, the extensive work-up is likely cost-effective.
在全科医疗中确定贫血的潜在病因是一项诊断挑战。目前，全科医生各自决定进行哪些实验室检查（常规检查）以诊断潜在病因。然而，全面检查（包括14项检查）可提高正确诊断患者的比例。本研究调查了这种全面检查的成本效益。方法：建立了一个决策分析模型，纳入了从患者因疑似贫血症状（年龄≥50岁）就诊于全科医生开始，直至患者在初级保健中被（正确）诊断和治疗，或被转诊至（并在）二级保健中诊断的所有社会成本。模型输入数据来自对全科医生的在线调查、专家估计和已发表的数据。主要结局指标表示为在任何一种检查中每多诊断出一名患有贫血正确潜在病因的患者的增量成本。结果：全科医生诊断出正确潜在病因的概率从常规检查中的49.6%（95%CI：44.8%至54.5%）增加到全面检查中的56.0%（95%CI：51.2%至60.8%）（即增加6.4%[95%CI：-0.6%至13.1%]）。成本预计将从每位患者842欧元（95%CI：704欧元至994欧元）略有增加至每位患者845欧元（95%CI：711欧元至994欧元），即在全面检查中每位患者增加3欧元（95%CI：-35欧元至40欧元），表明每多正确诊断一名患者的增量成本为43欧元。结论：全面的实验室检查对于全科医生诊断贫血的潜在病因更有效，成本增加极少。由于本分析未考虑生活质量和生产力损失降低等附带益处，全面检查可能具有成本效益。
