Specker B L, Saenger E L, Buncher C R, McDevitt R A
Department of Pediatrics, University of Cincinnati, Ohio.
J Nucl Med. 1987 Oct;28(10):1521-30.
The cost-effectiveness of pulmonary imaging (lung scan) on the management of 2,023 patients was studied. Prior and postscan probabilities of pulmonary embolism (PE) were obtained from referring physicians. After the scan, anticoagulant therapy (ACT) was appropriately changed in 20% of the patients and confirmed in 67%. The incremental cost of scanning was $124 per patient when the prior probability was 0.01-9.99%, dropping to $38 when the probability was 10-25%. Hospitalization and ACT cost was reduced when the prior probability was 25.01-99.99%. The greatest benefit in lives saved was when the prior probability was 25-74.99%; 1.5% of this probability group would survive as a result of the change in management attributable to the scan, at a cost of $117 per life saved. The benefit:risk ratio, as measured by lives saved compared to estimates of lives lost due to radiation exposure, was of the order of 6,000:1.
对2023例患者进行肺部成像（肺部扫描）管理的成本效益进行了研究。肺栓塞（PE）的扫描前和扫描后概率由转诊医生提供。扫描后，20%的患者抗凝治疗（ACT）得到适当改变，67%得到确认。当先前概率为0.01 - 9.99%时，扫描的增量成本为每位患者124美元，当概率为10 - 25%时降至38美元。当先前概率为25.01 - 99.99%时，住院和ACT成本降低。在挽救生命方面最大的益处是当先前概率为25 - 74.99%时；该概率组中有1.5%的患者将因扫描导致的管理改变而存活，每挽救一条生命的成本为117美元。以挽救的生命与因辐射暴露估计失去的生命相比衡量的效益风险比约为6000:1。
