CT与MRI在脑血管疾病诊断中有效性的评价及费用—效果分析
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摘要
目的:比较CT与MRI在诊断脑血管疾病时的有效性以及费用-效果比,从而在不同的诊断方案中选择兼具有效性和经济性的最佳诊断策略,为各级卫生决策者提供决策依据。
方法:本研究采用回顾性调查方法,收集了山西省4所综合性三级甲等医院脑血管疾病住院患者共720例的相关资料进行分析。
①通过CT与MRI的诊断阳性率、CT与MRI与入院前诊断的一致率以及CT与MRI各项诊断性试验测量指标的研究,评价CT与MRI对脑血管疾病的诊断价值。
②将186例脑梗塞患者和179例脑出血患者均分为CT诊断组和MRI诊断组,以患者住院时的实际诊断费用核计CT与MR工各自的诊断费用,以患者的诊断准确性作为效果指标。利用决策树模型,进行两种方案诊断脑梗塞及脑出血的费用—效果分析。
结果:
①脑梗塞患者中:50岁以下患者28例,占15.10%,70岁以上患者65例,占34.90%,随着年龄的增长,其患病率逐渐增加。男性患者134例,占72.00%。伴随的其他疾病依次为:高血压、糖尿病、心脏病、高脂血症。其中61例患者伴有高血压,占32.80%。在年龄、性别、发病部位及既往史方面无差别,两组具有可比性。脑出血患者中:50岁以下患者16例,占8.95%,50岁以上患者163例,占91.06%,随着年龄增长,其患病率亦逐渐升高。男性患者115例,占64.25%。伴随的其他疾病依次为:高血压、糖尿病、心脏病、高脂血症。其中23例患者伴有高血压,占12.85%。在年龄、性别及既往史方面无差别,两组具有可比性。
②两组诊断方案CT与MRI在脑皿管疾病的诊断中,MRI各项诊断准确性的指标均优于CT的相应指标。
③利用决策树模型,进行CT与MRI诊断脑梗塞和脑出血的费用-效果分析。结果显示:CT与MRI诊断总费用分别为:2320000元,4570000元。每诊断出一例真正的脑梗塞患者,CT与MRI的诊断费用分别为:326.62元,576.95元;每诊断出一例真正的非脑梗塞患者,CT与MRI的诊断费用分别为:255.31元,486.27元;每诊断出一例真正的脑出血患者,CT与MRI的诊断费用分别为:295.88元,567.49;每诊断出一例真正的非脑出血患者,CT与MRI的诊断费用分别为:243.37元,457.82元。
④对两组诊断方案CT与MRI进行敏感度分析,分析结果验证了两种诊断方案受参数影响不大。
结论:
①单从诊断效果来看,MRI比之CT对脑血管疾病有更高的诊断价值。因此,对于一些微小病灶、较不易发现病灶的患者或者经济条件较好只关注诊断效果的患者,建议首选MRI诊断。但综合考虑费用和效果的话,CT比MRI具有更好的费用-效果比,因此对于较大病灶的普通脑梗塞或脑出血患者,建议首选CT诊断。
②应加强对50岁以上中老年人脑血管疾病的宣传教育,提高他们对脑血管疾病临床症状、致病因素以及预防措施的认识,及早识别脑血管疾病,从而减少脑血管疾病的发生。
③应加强大型医疗设备的成本管理,优化CT与MR工的配置,杜绝医务人员引发的“诱导需求”,转变患者“过度消费”的心理,合理利用CT与MRI,使二者发挥最佳的诊断效果,取得最佳的经济效益。
Objective:To compare validity and cost-effective ratio of CT and MRI in diagnosis of cerebrovascular disease and to provide suggestion for selecting valid and cheaper way in clinic diagnosis.
Methods:The retrospective method was used in present research.Four hospitals ranked first class on the tertiary level in Shanxi province,were surveyed.Seven hundred and twenty cases of cerebrovascular disease,were collected.
①Data related to different index of the diagnostic value system to evaluate the diagnostic validity of CT and MRI.
②All the cases were divided into two groups:CT group and MRI group.Cost-effectiveness ratio was calculated in our research.Cost was estimated by the actual diagnostic cost,and effectiveness was estimated by the diagnostic accuracy.A decision tree model was used to make a decision analysis on the cost-effectiveness ratio of the two strategies of cerebral infraction and intracerebral hemorrhage
Results:
①Fifteen percent of the cerebral infraction patients are younger than 50 years old,and 34.9% of them are over 70 years old.Prevalence rate is increasing by age.Diseases companied with cerebral infraction ranked hypertension,diabetes,cardiac disease and hyperlipemia by turns. Thirty three percent of the cases suffered from hypertension.There is no difference in the age, sex,disease area and the past history diseases.Nine percent of patient suffered from intracerebral hemorrhage are younger than 50 years old,and 91.06%of them are over 70 years old.Prevalence rate is increasing by age.Diseases companied with cerebral infraction ranked hypertension,diabetes,cardiac disease and hyperlipemia by turns.Thirteen percent of the cases suffered from hypertension.There is no difference in the age,sex,disease area and the past history diseases.
②MRI has the better diagnostic accurancy in diagnosis of cerebrovascular disease by comparing to CT.
③The total cost of the CT and MRI was,respectively,2320000 yuan and 4570000 yuan.The cost of CT and MRI was,respectively,326.26 yuan and 576.95 yuan for every diagnosed patient with cerebral infraction.It was 255.31 yuan and 486.27 yuan for every diagnosed patient with non-cerebral infraction patient.It was 295.88 yuan and 567.49 yuan for every diagnosed patient with intracerebral hemorrhage patient.It was 243.37 yuan and 457.82 yuan every diagnosed patient with non-intracerebral hemorrhage patient.
④Sensitivity analysis shows that the research results are effected little by the parameters of the model.
Conclusions:
①MRI has better diagnostic accurancy than CT,so we suggest MRI should be as the first choice if not considering the cost,especially for the mini disease focus.But CT possessed better cost-effectiveness ratio than MRI for its lower price.So for diagnosing some frequent cerebrovascular disease,we suggest CT should be as the first choice.
②Knowledge of cerebrovascular disease should be popular in population of over 50 years old in order to diagnose and prevent it earlier.
③We should enforce the cost management of big medical equipments,improve the diffusion of them,avoid the induced need of the health providers,and transfer the exceeded consumption attitude of the patients.We should apply the two diagnostic strategies rationally to get the best diagnostic value and economic benefit.
方法:本研究采用回顾性调查方法,收集了山西省4所综合性三级甲等医院脑血管疾病住院患者共720例的相关资料进行分析。
①通过CT与MRI的诊断阳性率、CT与MRI与入院前诊断的一致率以及CT与MRI各项诊断性试验测量指标的研究,评价CT与MRI对脑血管疾病的诊断价值。
②将186例脑梗塞患者和179例脑出血患者均分为CT诊断组和MRI诊断组,以患者住院时的实际诊断费用核计CT与MR工各自的诊断费用,以患者的诊断准确性作为效果指标。利用决策树模型,进行两种方案诊断脑梗塞及脑出血的费用—效果分析。
结果:
①脑梗塞患者中:50岁以下患者28例,占15.10%,70岁以上患者65例,占34.90%,随着年龄的增长,其患病率逐渐增加。男性患者134例,占72.00%。伴随的其他疾病依次为:高血压、糖尿病、心脏病、高脂血症。其中61例患者伴有高血压,占32.80%。在年龄、性别、发病部位及既往史方面无差别,两组具有可比性。脑出血患者中:50岁以下患者16例,占8.95%,50岁以上患者163例,占91.06%,随着年龄增长,其患病率亦逐渐升高。男性患者115例,占64.25%。伴随的其他疾病依次为:高血压、糖尿病、心脏病、高脂血症。其中23例患者伴有高血压,占12.85%。在年龄、性别及既往史方面无差别,两组具有可比性。
②两组诊断方案CT与MRI在脑皿管疾病的诊断中,MRI各项诊断准确性的指标均优于CT的相应指标。
③利用决策树模型,进行CT与MRI诊断脑梗塞和脑出血的费用-效果分析。结果显示:CT与MRI诊断总费用分别为:2320000元,4570000元。每诊断出一例真正的脑梗塞患者,CT与MRI的诊断费用分别为:326.62元,576.95元;每诊断出一例真正的非脑梗塞患者,CT与MRI的诊断费用分别为:255.31元,486.27元;每诊断出一例真正的脑出血患者,CT与MRI的诊断费用分别为:295.88元,567.49;每诊断出一例真正的非脑出血患者,CT与MRI的诊断费用分别为:243.37元,457.82元。
④对两组诊断方案CT与MRI进行敏感度分析,分析结果验证了两种诊断方案受参数影响不大。
结论:
①单从诊断效果来看,MRI比之CT对脑血管疾病有更高的诊断价值。因此,对于一些微小病灶、较不易发现病灶的患者或者经济条件较好只关注诊断效果的患者,建议首选MRI诊断。但综合考虑费用和效果的话,CT比MRI具有更好的费用-效果比,因此对于较大病灶的普通脑梗塞或脑出血患者,建议首选CT诊断。
②应加强对50岁以上中老年人脑血管疾病的宣传教育,提高他们对脑血管疾病临床症状、致病因素以及预防措施的认识,及早识别脑血管疾病,从而减少脑血管疾病的发生。
③应加强大型医疗设备的成本管理,优化CT与MR工的配置,杜绝医务人员引发的“诱导需求”,转变患者“过度消费”的心理,合理利用CT与MRI,使二者发挥最佳的诊断效果,取得最佳的经济效益。
Objective:To compare validity and cost-effective ratio of CT and MRI in diagnosis of cerebrovascular disease and to provide suggestion for selecting valid and cheaper way in clinic diagnosis.
Methods:The retrospective method was used in present research.Four hospitals ranked first class on the tertiary level in Shanxi province,were surveyed.Seven hundred and twenty cases of cerebrovascular disease,were collected.
①Data related to different index of the diagnostic value system to evaluate the diagnostic validity of CT and MRI.
②All the cases were divided into two groups:CT group and MRI group.Cost-effectiveness ratio was calculated in our research.Cost was estimated by the actual diagnostic cost,and effectiveness was estimated by the diagnostic accuracy.A decision tree model was used to make a decision analysis on the cost-effectiveness ratio of the two strategies of cerebral infraction and intracerebral hemorrhage
Results:
①Fifteen percent of the cerebral infraction patients are younger than 50 years old,and 34.9% of them are over 70 years old.Prevalence rate is increasing by age.Diseases companied with cerebral infraction ranked hypertension,diabetes,cardiac disease and hyperlipemia by turns. Thirty three percent of the cases suffered from hypertension.There is no difference in the age, sex,disease area and the past history diseases.Nine percent of patient suffered from intracerebral hemorrhage are younger than 50 years old,and 91.06%of them are over 70 years old.Prevalence rate is increasing by age.Diseases companied with cerebral infraction ranked hypertension,diabetes,cardiac disease and hyperlipemia by turns.Thirteen percent of the cases suffered from hypertension.There is no difference in the age,sex,disease area and the past history diseases.
②MRI has the better diagnostic accurancy in diagnosis of cerebrovascular disease by comparing to CT.
③The total cost of the CT and MRI was,respectively,2320000 yuan and 4570000 yuan.The cost of CT and MRI was,respectively,326.26 yuan and 576.95 yuan for every diagnosed patient with cerebral infraction.It was 255.31 yuan and 486.27 yuan for every diagnosed patient with non-cerebral infraction patient.It was 295.88 yuan and 567.49 yuan for every diagnosed patient with intracerebral hemorrhage patient.It was 243.37 yuan and 457.82 yuan every diagnosed patient with non-intracerebral hemorrhage patient.
④Sensitivity analysis shows that the research results are effected little by the parameters of the model.
Conclusions:
①MRI has better diagnostic accurancy than CT,so we suggest MRI should be as the first choice if not considering the cost,especially for the mini disease focus.But CT possessed better cost-effectiveness ratio than MRI for its lower price.So for diagnosing some frequent cerebrovascular disease,we suggest CT should be as the first choice.
②Knowledge of cerebrovascular disease should be popular in population of over 50 years old in order to diagnose and prevent it earlier.
③We should enforce the cost management of big medical equipments,improve the diffusion of them,avoid the induced need of the health providers,and transfer the exceeded consumption attitude of the patients.We should apply the two diagnostic strategies rationally to get the best diagnostic value and economic benefit.
引文
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[1]李军,杨国忠.医学技术评估及其展望.中国卫生事业管理,2001,8:452
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[3]陈洁.医学技术评估.上海:上海医科大学出版社,1996,4
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[6]werko,L·Bantao D.Report from the EUR-ASSESS project,International journalof Technology Assessmentin Health Care,1995,11:797
[7]李静.卫生技术评估与循证医学.华西医学,2000,15(1):6
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[1]李军,杨国忠.医学技术评估及其展望.中国卫生事业管理,2001,8:452
[2]刘晓强.卫生技术评估的发展.国外医学(卫生经济分册),2003,20(4):146
[3]陈洁.医学技术评估.上海:上海医科大学出版社,1996,4
[4]吕军,陈洁.伽玛刀的医学技术评估(J).中华医院管理杂志.1999(15):103
[5]www.Inahta.org.
[6]werko,L·Bantao D.Report from the EUR-ASSESS project,International journalof Technology Assessmentin Health Care,1995,11:797
[7]李静.卫生技术评估与循证医学.华西医学,2000,15(1):6
[8]Clifford S.Goodman.TA101 Introduction to Health Care Technology Assessment,1998
[9]A Stevens et al.keeping pace with new technologies.Systems needed to identify and evaluate them.BMJ,1999,319:1291
[10]李幼平,王莉.HTA与卫生决策.中国循证医学,2001,8(1):67
[11]张国良,史忠道.卫生技术评估对临床医疗实践的影响.医学与哲学.2003,2:29-31
[12]李静,李幼平.卫生技术评估与循证医学.WEST CHINA JOURNAL,2000,15:6-9
[13]Fineberg HV.,Parker GS.,Pearlman LA.CT Scanner:distribution and planning status in the United States.New England journal of Medicine,1977,297(4):216-218
[14]Hallinan J.Standards of Practice in C T.Australas Radiol,1977,21(2):110-111
[15]Simon DG,Lubin MF.Cost-effectiveness of computerized tomography and magnetic resonance imaging in dementia Med Decis Making,1985,5(3):335-354
[16]Eddy RJ.Cost-effectiveness of CT scanning compared with mediastinoscopy in the preoperative staging of lung cancer.Can Assoc Radiol J,1989,40(4):189-193
[17]吕军,陈洁.伽玛刀的医学技术评估(J).中华医院管理杂志,1999,15:103
[18]刘阿力,Leksell.伽玛刀的立体定向放射外科.引进国外医疗技术和设备,1998,2:22-23
[19]鲍金花.伽玛刀的临床应用与展望.医学信息,1996,6:1-2
[20]陈洁.医学技术评估.上海:上海医科大学出版社,1996,143
[21]刘越泽.磁共振成像安全性和有效性评价.中华医院管理杂志,2004,20:610-614
[22]刘越泽.磁共振成像对门诊患者诊断价值的评价.中华医学论坛,2004,3:5-6
[23]刘越泽.磁共振成像对住院患者诊断价值的评价.中华医学论坛,2004,3:7-9
[24]刘越泽.山西省磁共振成像的成本—效益分析.中华医院管理杂志,2004,20(5):271-273
[25]刘越泽,卢祖洵.影响山两省磁共振成像的成本—效益因素的分析.中华医院管理杂志,2004,20(5):274-276
[26]刘越泽,卢祖洵.山西省磁共振成像的投资风险及对策.中华医院管理杂志,2004,20(5):277-279
[27]刘越泽.磁共振成像的卫生技术评估.中华医学论坛,2004,3:1-2
[28]张晋兴,刘越泽.磁共振成像运行中经济收益分析.中华医学论坛,2004,3:10-13
[29]Yueze Liu,Jianwen Cao,Zuxun Lu.Allocation suatus of MRI in Shanxi Province,P.R.China.China Journal of Procatical medicine hygiene,2004,2:1-5
[30]Yueze Liu,Jianwen Cao,Zuxun Lu.Health Technology Assessment of Magnetic Resonanee Imaging in Shaanxi Province.China Journal of Procatical medicine hygiene,2004,2:85-90
[31]陈文,应晓华.成本效果分析的理论基础.卫生经济研究,2002,12:9
[32]陈晓明.卫生经济学.北京:人民卫生出版社,2003,328-329
[33]胡善联.卫生经济学.上海:复旦大学出版社,2002,317-319
[34]田文华.成本-效益与成本-效果分析.解放军医院管理杂志,1995,2(1):76-79
[35]陈晓明.卫生经济学.北京:人民卫生出版社.2003,329
[36]邵元福.两种非类固醇抗发炎药物治疗类风湿关节炎的成本-效用分析.上海长征医院药材科
[37]林爱华,方积乾.两地孕产妇产前检查方案的成本效果比较.中国卫生统计,1999,3(16)
[38]高晓凤.医疗卫生服务成本-效果分析方法简介(综述).《国外医学》卫生经济分册,2003,20:4-8
[39]许景峰.药物经济学优化治疗方案,指导临床合理用药.(北京军区总医院 北京 100700)
[40]陈洁.医学技术评估.上海:上海医科大学出版社,第一版.1996,151
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