Anis A H, Stiell I G, Stewart D G, Laupacis A
Department of Health Care and Epidemiology, University of British Columbia, Vancouver, Canada.
Ann Emerg Med. 1995 Oct;26(4):422-8. doi: 10.1016/s0196-0644(95)70108-7.
To conduct an incremental cost-effectiveness analysis of implementation of the Ottawa Ankle Rules in emergency departments in the United States and Canada.
A decision analytic approach to technology assessment. Clinical decision rules that allow physicians to be more selective in their use of radiography were compared with current practice in a decision analytic model.
A university hospital adult ED.
ED physicians instructed in the use of the Ottawa Ankle Rules for adult patients with ankle injury.
Radiography, waiting time, lost productivity, and medicolegal costs were calculated. In the United States, the savings varied between US$614,226 and US$3,145,910 per 100,000 patients, depending on the charge rate for radiography. In Ontario, Canada, the total savings were CAN$730,145 per 100,000 patients. One- and two-way sensitivity analyses that varied the rate of missed fractures, cost of radiography, probability of lawsuits, and cost of lawsuits did not change the results substantially.
Implementation of the Ottawa Ankle Rules would result in significant savings of health care dollars despite the cost of missed fractures including litigation costs.
对美国和加拿大急诊科实施渥太华踝关节规则进行增量成本效益分析。
一种技术评估的决策分析方法。在决策分析模型中，将允许医生更有选择性地使用X光检查的临床决策规则与当前实践进行比较。
一家大学医院的成人急诊科。
接受过渥太华踝关节规则使用培训的急诊科医生，用于治疗成年踝关节损伤患者。
计算了X光检查、等待时间、生产力损失和医疗法律成本。在美国，每10万名患者节省的费用在614,226美元至3,145,910美元之间，具体取决于X光检查的收费率。在加拿大安大略省，每10万名患者总共节省730,145加元。对漏诊骨折率、X光检查成本、诉讼概率和诉讼成本进行的单向和双向敏感性分析，结果没有实质性变化。
尽管存在漏诊骨折的成本，包括诉讼成本，但实施渥太华踝关节规则将显著节省医疗费用。
