Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
J Vasc Interv Radiol. 2023 Jul;34(7):1115-1125.e17. doi: 10.1016/j.jvir.2023.03.001. Epub 2023 Mar 8.
To systematically review cost research in interventional radiology (IR) published since the Society of Interventional Radiology Research Consensus Panel on Cost in December 2016.
A retrospective assessment of cost research in adult and pediatric IR since December 2016 to July 2022 was conducted. All cost methodologies, service lines, and IR modalities were screened. Analyses were reported in a standardized fashion to include service lines, comparators, cost variables, analytical processes, and databases used.
There were 62 studies published, with most from the United States (58%). Incremental cost-effectiveness ratio, quality-adjusted life-years, and time-driven activity-based costing (TDABC) analyses were performed in 50%, 48%, and 10%, respectively. The most frequently reported service line was interventional oncology (21%). No studies on venous thromboembolism, biliary, or IR endocrine therapies were found. Cost reporting was heterogeneous owing to varying cost variables, databases, time horizons, and willingness-to-pay (WTP) thresholds. IR therapies were more cost-effective than their non-IR counterparts for treating hepatocellular carcinoma ($55,925 vs $211,286), renal tumors ($12,435 vs $19,399), benign prostatic hyperplasia ($6,464 vs $9,221), uterine fibroids ($3,772 vs $6,318), subarachnoid hemorrhage ($1,923 vs $4,343), and stroke ($551,159 vs $577,181). TDABC identified disposable costs contributing most to total IR costs: thoracic duct embolization (68%), ablation (42%), chemoembolization (30%), radioembolization (80%), and venous malformations (75%).
Although much of the contemporary cost-based research in IR aligned with the recommendations by the Research Consensus Panel, gaps remained in service lines, standardization of methodology, and addressing high disposable costs. Future steps include tailoring WTP thresholds to nation and health systems, cost-effective pricing for disposables, and standardizing cost sourcing methodology.
系统回顾自 2016 年 12 月介入放射学研究共识小组发布成本共识以来发表的介入放射学（IR）成本研究。
对 2016 年 12 月至 2022 年 7 月成人和儿科 IR 的成本研究进行回顾性评估。筛选了所有成本方法、服务线和 IR 模式。分析结果以标准化的方式报告，包括服务线、对照物、成本变量、分析过程和使用的数据库。
共发表了 62 篇研究，其中大部分来自美国（58%）。50%、48%和 10%分别进行了增量成本效益比、质量调整生命年和时间驱动活动基础成本（TDABC）分析。报告最多的服务线是介入肿瘤学（21%）。没有静脉血栓栓塞、胆道或 IR 内分泌治疗的研究。由于不同的成本变量、数据库、时间范围和支付意愿（WTP）阈值，成本报告存在差异。与非 IR 治疗相比，IR 治疗肝癌（55925 美元比 211286 美元）、肾肿瘤（12435 美元比 19399 美元）、良性前列腺增生（6464 美元比 9221 美元）、子宫肌瘤（3772 美元比 6318 美元）、蛛网膜下腔出血（1923 美元比 4343 美元）和中风（551159 美元比 577181 美元）的成本效益更高。TDABC 确定了导致 IR 总成本最大的可支配成本：胸导管栓塞（68%）、消融（42%）、化疗栓塞（30%）、放射性栓塞（80%）和静脉畸形（75%）。
尽管 IR 中大部分基于成本的研究与研究共识小组的建议一致，但在服务线、方法标准化和解决高可支配成本方面仍存在差距。未来的步骤包括根据国家和卫生系统调整 WTP 阈值、对可支配物品进行成本效益定价以及标准化成本来源方法。
