Cost and Radiation Savings of Partial Substitution of Ultrasound for CT in Appendicitis Evaluation: A National Projection
Cost and Radiation Savings of Partial Substitution of Ultrasound for CT in Appendicitis Evaluation: A National Projection
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DOI：
10.2214/ajr.12.9642
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发表时间：
2014-01-01
影响因子：
5
通讯作者：
Frangos, Andrea J.
中科院分区：
文献类型：
--
作者：
Parker, Laurence;Nazarian, Levon N.;Frangos, Andrea J.
OBJECTIVE.比较超声-CT方案和仅CT方案用于阑尾炎评估的成本。对于超声-CT方案，患有右下腹疼痛的患者接受超声检查。如果是阑尾炎阳性，他们被直接送往手术，避免CT。材料和方法。进行了一项比较有效性研究。估计了超声- CT方案的影像学检查、额外手术和额外手术死亡的成本，以及仅CT方案的影像学检查和额外癌症死亡的成本。数据来源是医疗保险和医疗补助服务中心（CMS）数据集，全国医院出院调查，放射信息系统的情况下，和美国。S.人口普查局的寿命表。还进行了荟萃分析和敏感性分析。荟萃分析显示CT和超声的阳性预测值分别为92.5%和91.0%。CMS文件的分析显示，CT的使用几乎正好是每例患者2.0次检查（一次腹部和一次盆腔），而超声几乎为零。这种成像方案的成本为每位患者547美元，而有限的超声研究的成本为每位患者88美元。对于总的U。S.在这一人口中，每年在成像方面节省的费用减去额外手术和额外手术死亡的费用为2 490万美元。根据电离辐射生物效应委员会（BEIR）提出的模型VII（称为“BEIR VII”），避免262，500人受到12.4 mSv的照射将防止180例癌症死亡。损失的寿命年数价值为3.395亿美元。敏感性分析表明，成本节约是稳健的。与标准的仅CT方案相比，用于阑尾炎评估的超声CT方案可能会节省大量费用。使用较便宜的成像技术可以适度节省费用，尽管需要额外的手术，并且可以避免大量的辐射暴露。
OBJECTIVE. The costs of an ultrasound-CT protocol and a CT-only protocol for an appendicitis evaluation are compared. For the ultrasound-CT protocol, patients with right lower quadrant abdominal pain undergo an ultrasound examination. If it is positive for appendicitis, they are sent directly to surgery, avoiding CT.MATERIALS AND METHODS. A comparative effectiveness research study was conducted. The costs of imaging tests, excess surgeries, and excess surgical deaths for the ultrasound- CT protocol and the costs of imaging tests and excess cancer deaths in the CT-only protocol were estimated. Data sources were Centers for Medicare & Medicaid Services (CMS) datasets, national hospital discharge surveys, radiology information system cases, and U. S. Census Bureau life tables. A meta-analysis and sensitivity analyses were also conducted.RESULTS. The meta-analysis showed a positive predictive value of 92.5% for CT and 91.0% for ultrasound. Analysis of CMS files showed that utilization of CT was almost exactly 2.0 examinations (one abdominal and one pelvic) per patient and for ultrasound was almost nil. The cost of this imaging protocol was $547 per patient, whereas the cost of a limited ultrasound study would be $ 88 per patient. For the total U. S. population, the cost savings in imaging minus the cost of extra surgeries and extra surgical deaths is $24.9 million per year. Following model VII proposed by the Committee on the Biological Effects of Ionizing Radiation (BEIR), which is known as "BEIR VII," the avoidance of a 12.4-mSv exposure for 262,500 persons would prevent 180 excess cancer deaths. The value of the years of life lost would be $339.5 million. The sensitivity analyses indicate that the cost savings are robust.CONCLUSION. An ultrasound-CT protocol for appendicitis evaluation offers potentially large savings over the standard CT-only protocol. There are moderate savings from using a less expensive imaging technique despite extra surgeries and large savings from radiation exposure avoided.