Barry M J, Mulley A G, Richter J M
Gastroenterology. 1987 Aug;93(2):301-10. doi: 10.1016/0016-5085(87)91019-5.
Physicians respond to a positive fecal occult blood test with a variety of workup strategies. To study the effect of the choice of strategy on the net costs and health benefits of colorectal cancer screening using this test, we used a decision analysis model to compare seven strategies that physicians might choose to examine a positive "screenee." Strategies using rigid or flexible sigmoidoscopy alone are not only insensitive, but also have high cost-effectiveness ratios. The strategy of air contrast barium enema alone had the lowest cost-effectiveness ratio. Rigid sigmoidoscopy combined with barium enema had a lower cost-effectiveness ratio than primary colonoscopy, but the strategy of primary colonoscopy could have an equal or better ratio depending on assumptions about test costs and the benefit of removing benign polyps. The primary colonoscopy strategy is both more effective and less costly than the combination of flexible sigmoidoscopy and barium enema. The optimal strategy will vary with local factors, and with the perspective of the decision-maker.
医生会采用多种检查策略来应对粪便潜血试验呈阳性的情况。为研究策略选择对使用该检测进行结直肠癌筛查的净成本和健康效益的影响，我们使用决策分析模型比较了医生可能选择用于检查阳性“受检者”的七种策略。仅使用硬性或软性乙状结肠镜检查的策略不仅敏感性低，而且成本效益比高。单独使用气钡双重造影灌肠的策略成本效益比最低。硬性乙状结肠镜检查联合钡灌肠的成本效益比低于初次结肠镜检查，但根据对检测成本和切除良性息肉益处的假设，初次结肠镜检查策略可能具有相同或更好的成本效益比。初次结肠镜检查策略比软性乙状结肠镜检查和钡灌肠联合使用更有效且成本更低。最佳策略会因当地因素以及决策者的角度而有所不同。
