Gambhir S S, Shepherd J E, Shah B D, Hart E, Hoh C K, Valk P E, Emi T, Phelps M E
Crump Institute for Biological Imaging, University of California Los Angeles School of Medicine 90095-1770, USA.
J Clin Oncol. 1998 Jun;16(6):2113-25. doi: 10.1200/JCO.1998.16.6.2113.
Multiple strategies are currently being used to manage patients who present with indeterminate solitary pulmonary nodules (SPN). We have used decision-analysis models to assess the cost-effectiveness of various strategies for the diagnosis and management of SPN. Four decision strategies were compared: a wait and watch strategy, a surgery strategy, a computed tomography (CT)-based strategy, and a CT-plus-positron emission tomography (PET) strategy. An incremental cost-effectiveness ratio (ICER) was used to compare all strategies to the wait and watch strategy.
A CT-plus-PET strategy was the most cost-effective over a large pretest likelihood (probability of having a malignant nodule), with a range of 0.12 to 0.69. Furthermore, within this likelihood range, the potential cost savings of using the CT-plus-PET strategy over the CT strategy ranged from $91 to $2,200 per patient. This translates to a yearly national savings of approximately $62.7 million.
Decision-analysis modeling indicates the potential cost-effectiveness of [18F]2-fluoro-2-deoxy-D-glucose (FDG)-PET in the management of SPN. Furthermore, the decision trees developed can be used to model various features of the management of SPN, including modeling the cost-effectiveness of other newly emerging technologies.
目前正在采用多种策略来管理出现孤立性肺结节（SPN）且性质不确定的患者。我们使用决策分析模型来评估SPN诊断和管理的各种策略的成本效益。比较了四种决策策略：观察等待策略、手术策略、基于计算机断层扫描（CT）的策略以及CT加正电子发射断层扫描（PET）策略。采用增量成本效益比（ICER）将所有策略与观察等待策略进行比较。
在较大的检测前概率（恶性结节的概率）范围内，即0.12至0.69，CT加PET策略是最具成本效益的。此外，在此概率范围内，使用CT加PET策略相对于CT策略每位患者潜在的成本节省范围为91美元至2200美元。这意味着每年全国可节省约6270万美元。
决策分析模型表明[18F]2-氟-2-脱氧-D-葡萄糖（FDG）-PET在SPN管理中的潜在成本效益。此外，所开发的决策树可用于对SPN管理的各种特征进行建模，包括对其他新兴技术的成本效益进行建模。
