Cost-effectiveness of whole-body CT screening
Cost-effectiveness of whole-body CT screening
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DOI：
10.1148/radiol.2342032061
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发表时间：
2005-02-01
期刊：
影响因子：
19.7
通讯作者：
Gazelle, GS
中科院分区：
文献类型：
--
作者：
Beinfeld, MT;Wittenberg, E;Gazelle, GS
目的：初步估计全身计算机断层扫描 (CT) 筛查的有效性（以生命年为单位）和成本效益（以每生命年的成本为单位）。 材料和方法：通过使用决策分析模型计算一次性全身 CT 筛查相对于不进行筛查的成本和有效性（以生命年为单位）。据认为，筛查带来的任何好处都是由于较早发现疾病以及相对于常规护理的生存率而言生存率的改善。该模型包含八种疾病：卵巢癌、胰腺癌、肺癌、肝肾癌和结肠癌；腹主动脉瘤;和冠状动脉疾病。估算了筛查检查、后续测试和患者护理的费用。基本案例分析是针对 50 万名自我介绍的无症状 50 岁男性的假设队列进行的。对于敏感性分析，队列的年龄和性别各不相同。：结果以每延长生命年 2001 美元表示。结果：与常规护理相比，全身 CT 筛查在预期寿命上的延长甚微（0.016 6 年或 6 天），每位患者的平均额外成本为 2513 美元，或每延长生命年的增量成本效益比为 151 000 美元。大多数患者 (90.8%) 至少有一项阳性发现，但只有 2.0% 患有疾病；筛查假阳性患者的检查费用占总费用的 32.3%（5,332 美元中的 1,720 美元）。结果对疾病的患病率、筛查对诊断时疾病阶段的影响、筛查的特异性以及假阳性结果的随访成本敏感。结论：即使有利于全身 CT 的假设，与目前资助的医疗干预措施相比，实施一次性筛查也不具有成本效益；对假阳性结果的后续调查将给医疗保健系统增加巨大的经济负担。
PURPOSE: To make preliminary estimates of the effectiveness (in life-years) and cost-effectiveness (in costs per life-year) of whole-body computed tomographic (CT) screening.MATERIALS AND METHODS: Costs and effectiveness (in life-years) of onetime whole-body CT screening relative to those of no screening were calculated by using a decision-analytic model. It was assumed that any benefits from screening were due to earlier detection of disease and improvement in survival relative to survival with routine care. Eight conditions were included in the model: ovarian, pancreatic, lung, liver kidney, and colon cancer; abdominal aortic aneurysm; and coronary artery disease. Costs of the screening examination, follow-up tests, and patient care were estimated. The base-case analysis was performed for a hypothetical cohort of 500 000 self-referred asymptomatic 50-year-old men. For sensitivity analyses, the age and sex of the cohort were varied.:Results were expressed in 2001 U.S. dollars per life-year gained.RESULTS: Compared with routine care, whole-body CT screening provided minimal gains in life expectancy (0.016 6 years or 6 days) at an average additional cost of $2513 per patient, or an Incremental cost-effectiveness ratio of $151 000 per life-year gained. Most patients (90.8%) had at least one positive finding, but only 2.0% had disease; work-up in patients With a false-positive result of screening accounted for 32.3% of total costs ($1720 of $5332). Results were sensitive to the prevalence of disease, the effect of-screening on stage of disease at diagnosis, the specificity of screening, and the costs of follow-up for false-positive findings.CONCLUSION: Even with assumptions favorable to whole-body CT, implementation of onetime screening would not be, cost-effective compared with currently funded medical interventions; follow-up for false-positive findings would add a substantial financial burden to the health care system.