Department of Diagnostic Imaging, National University Hospital, National University Health System, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
Duke-NUS Medical School, Singapore.
Value Health. 2021 Dec;24(12):1754-1762. doi: 10.1016/j.jval.2021.06.005. Epub 2021 Aug 5.
Early and accurate diagnosis of hip fractures minimizes morbidity and mortality. Although current guidelines favor magnetic resonance imaging (MRI) for the diagnosis of occult hip fractures, a new technology called dual-energy computed tomography (DECT) seems an effective alternative. This article investigates a potentially cost-effective strategy for the diagnosis of occult hip fractures in older adults in Singapore.
A decision tree model was developed to compare costs from a payer's perspective and outcomes in terms of quality-adjusted life-years (QALYs) of different imaging strategies for diagnosing occult hip fracture, comparing MRI with DECT supplementing single-energy computed tomography (SECT) and SECT alone. Model inputs were obtained from local sources where available. Sensitivity analyses are performed to test the robustness of the results.
The MRI strategy was dominated by the DECT strategy, whereas DECT supplementing SECT provided 0.30 more QALYs at an incremental cost of SGD106.41 with an incremental cost-effectiveness ratio of SGD352.52 per QALY relative to SECT alone. DECT seemed a cost-effective strategy at a willingness-to-pay threshold of SGD50 000 per QALY.
DECT supplementing SECT is a cost-effective imaging strategy to diagnose occult hip fractures among older adults in Singapore and should be included in clinical pathways to expedite timely treatment and considered for reimbursement schemes.
早期、准确的髋部骨折诊断可降低发病率和死亡率。尽管目前的指南倾向于使用磁共振成像（MRI）来诊断隐匿性髋部骨折，但一种名为双能 CT（DECT）的新技术似乎是一种有效的替代方法。本文研究了一种在新加坡针对老年隐匿性髋部骨折具有潜在成本效益的诊断策略。
我们开发了一个决策树模型，以比较不同成像策略（MRI 与 DECT 补充单能 CT（SECT）和单独 SECT）诊断隐匿性髋部骨折的成本和质量调整生命年（QALY）的结果，从支付者的角度进行比较。模型输入是在当地来源中获得的。进行敏感性分析以检验结果的稳健性。
MRI 策略被 DECT 策略所主导，而 DECT 补充 SECT 则在单独 SECT 的基础上提供了 0.30 个 QALY，增量成本为 106.41 新加坡元，增量成本效益比为每 QALY352.52 新加坡元。DECT 似乎是一种具有成本效益的策略，在每 QALY50000 新加坡元的支付意愿阈值下。
DECT 补充 SECT 是诊断新加坡老年隐匿性髋部骨折的一种具有成本效益的成像策略，应纳入临床路径以加快及时治疗，并考虑纳入报销计划。
