The high cost of syncope: Cost implications of a new insertable loop recorder in the investigation of recurrent syncope
The high cost of syncope: Cost implications of a new insertable loop recorder in the investigation of recurrent syncope
复制标题
DOI：
10.1016/s0002-8703(99)70411-4
复制
发表时间：
1999-05-01
影响因子：
4.8
通讯作者：
Manda, V
中科院分区：
文献类型：
--
作者：
Krahn, AD;Klein, GJ;Manda, V
复发性晕厥患者经常接受大量的检查，这消耗了大量的医疗资源。长期监测技术的最新进展提高了罕见症状患者的诊断率。有一点信息的相对成本效益的调查工具，用于在patients with syncope. Methods两种方法来确定晕厥患者的健康核心成本。在第一项研究中，确定了24例反复发生不明原因晕厥和阴性检查的患者的医疗保健资源利用率，这些患者在该器械可行性的初步研究期间接受了植入式循环记录仪（IIR）的插入。根据索引调查的中位数费用和对1993年以来1018例美国医疗保险医院晕厥索赔的回归分析，计算每例患者在1LR植入前、植入期间和植入后的调查费用。使用0.64的成本-费用比率将收费转换为成本。第二种方法是基于每次诊断的估计成本和已发表的晕厥患者6种常用检查的诊断率。一个队列模拟使用的理论模型，100例患者接受调查晕厥被创建比较的诊断率和成本，每诊断的各种诊断cascades.Results在试点研究中，在2年前插入IIR晕厥的调查成本为7584美元每例患者。插入1LR后，24例患者中有21例获得诊断（诊断率88%）。治疗费用为2452美元;随后在30 +/-10个月的随访中，护理费用降至596美元。在第二种方法中，单个测试的诊断率范围从超声心动图的3%到1LR的88%。每次诊断的成本从外部循环记录仪的529美元到无结构性心脏病患者的电生理测试的73，260美元不等。与IIR试点研究相似的晕厥方法导致每次诊断的成本为3193美元，诊断率为98%。超声心动图和电生理检查仅在有器质性心脏病的患者中进行，可将成本降低到2494美元，诊断率保持在98%。IIR可以通过提供允许确定性治疗的诊断来减少卫生保健资源的利用。目前晕厥患者常用的诊断试验的每次诊断成本差异很大。一个具有成本效益的方法来诊断这种疾病可以保持较高的诊断率，减少资源利用与传统的方法相比。
Background Patients with recurrent syncope frequently undergo extensive investigations that consume significant health care resources. Recent advances in long-term monitoring techniques have enhanced diagnostic yield in patients with infrequent symptoms. There is little information on the relative cost-effective profile of the investigative tools used in patients with syncope.Methods Two methods to determine health core costs in patients with syncope were used. In the first, health care resource utilization was determined in 24 patients with recurrent unexplained syncope and negative investigations who underwent insertion of the implantable loop recorder (IIR) during a pilot study of the feasibility of the device. The costs of investigations before,during, and after 1LR implantation in each patient were calculated on the basis of median charges for an index investigation and a regression analysis of 1018 US Medicare hospital claims For syncope From 1993. Charges were converted to costs using a cost-to-charge ratio of 0.64. The second method was based on estimated costs per diagnosis and published diagnostic yields of 6 commonly applied tests in patients with syncope. A cohort simulation using theoretic models of 100 patients undergoing investigation for syncope was created to compare the diagnostic yield and cost per diagnosis of various diagnostic cascades.Results In the pilot study, the cost of investigation of syncope in the 2 years before IIR insertion was $7584 per patient. After the 1LR was inserted,a diagnosis was obtained in 21 of 24 patients -(diagnostic yield 88%). The cost of therapy was $2452; followed by a reduction in cost of care to $596 over 30 +/- 10 months of follow-up. In the second method, the diagnostic yield of individual tests ranged from 3% for echocardiography to 88% For the 1LR. The cost per diagnosis obtained ranged from $529 for the external loop recorder to $73,260 for-electrophysiologic testing in patients without structural heart disease. An approach to syncope similar to that of the IIR pilot study resulted in a cost per diagnosis of $3193 and a diagnostic yield of 98%. Performance of echocardiography in half of the patients and electrophysiologic testing only in the presence of structural heart disease reduced the cost to $2494 and retained a diagnostic yield of 98%.Conclusions The cost of investigation of syncope is high. The IIR may reduce health care resource utilization by providing a diagnosis permitting definitive therapy. The cost per diagnosis profile of current diagnostic tests commonly used in patients with syncope is highly variable. A cost-effective approach to diagnosing this disorder can retain a high diagnostic yield with a reduction in resource utilization compared with a conventional approach.