Postsurgical surveillance of colon cancer - Preliminary cost analysis of physician examination, carcinoembryonic antigen testing, chest x-ray, and colonoscopy
Postsurgical surveillance of colon cancer - Preliminary cost analysis of physician examination, carcinoembryonic antigen testing, chest x-ray, and colonoscopy
复制标题
DOI：
10.1097/00000658-199807000-00009
复制
发表时间：
1998-07-01
影响因子：
9
通讯作者：
Haller, DG
中科院分区：
文献类型：
--
作者：
Graham, RA;Wang, S;Haller, DG
目的 本研究首次探讨了医生检查、癌胚抗原 (CEA) 评估、胸部 X 光检查和结肠镜检查在原发性结肠癌手术切除患者中检测复发性疾病的相对和绝对费用。方法对 0089 组间协议中 1356 名接受 Dukes' B2 和 C 型结肠癌手术切除的东部肿瘤合作组患者中的 421 名出现复发性疾病的患者进行了回顾。后续测试按照方案指南进行，每次测试的费用等于 1995 年医疗保险报销。随访时间定义为 421 名疾病复发患者的复发时间（平均 18.6 个月），或另外 930 名疾病未复发患者的最长 5 年（平均 38.6 个月）。患者被分为三类：非复发、复发但不可切除、复发但可出于治愈目的切除。计算了检测第 3 组（复发但可切除）患者的每次测试的估计平均成本。结果 在 421 名出现复发性疾病的患者中，96 例接受了以治愈为目的的疾病手术切除（第 3 组）。对于第 3 组患者，复发性疾病的首要指征是 CEA 检测 (30)、胸部 X 光检查 (12)、结肠镜检查 (14) 和其他 (40)。在 40 名“其他”患者中，24 人出现症状。然而，常规医生检查未能发现单一可切除的复发，医生检查的总费用为 418,615 美元。 CEA检测的检出率为2.2%，总费用为170,880美元，每次复发的费用为5,696美元。胸部X光检查的检出率为0.9%，总费用为120,934美元，每次复发费用为10,078美元。结肠镜检查的检出率为1%，总费用为641,344美元，每次复发的费用为45,810美元。 结论 CEA测量是检测潜在可治愈复发性疾病的最具成本效益的测试。就诊仅对评估症状有用；常规的医生检查没有额外的好处。
Objective This study is the first to examine the relative and absolute costs of physician examination, carcinoembryonic antigen (CEA) assessment, chest x-ray, and colonoscopy in detecting recurrent disease in patients who have undergone surgical resection for primary colon carcinoma.Methods Of the 1356 Eastern Cooperative Oncology Group patients in Intergroup Protocol 0089 who underwent surgical resection for Dukes' B2 and C colon carcinoma, 421 patients who developed recurrent disease were reviewed. Follow-up testing was performed according to protocol guidelines, with the cost of each test equal to 1995 Medicare reimbursement. Follow-up was defined as the time to recurrence for the 421 patients in whom disease recurred (mean 18.6 months) or up to 5 years for the additional 930 patients in whom disease did not recur (mean 38.6 months). Patients were divided into three categories: nonrecurrent, recurrent but not resectable, and recurrent but resectable with curative intent. The estimated mean cost of each test in detecting group 3 (recurrent but resectable) patients was calculated.Results Of the 421 patients who developed recurrent disease, 96 underwent surgical resection of their disease with curative intent (group 3). For group 3 patients, the first indication of recurrent disease was CEA testing (30), chest x-ray (12), colonoscopy (14), and other (40). Of the 40 "other" patients, 24 presented with symptoms. Routine physician examination, however, failed to identify a single resectable recurrence, and the total cost for physician examination was $418,615. The detection rate for CEA testing was 2.2%, the total cost was $170,880, and the cost per recurrence was $5,696. The detection rate for chest x-ray was 0.9%, the total cost was $120,934, and the cost per recurrence was $10,078. The detection rate of colonoscopy was 1%, the total cost was $641,344, and the cost per recurrence was $45,810.Conclusions CEA measurement was the most cost-effective test in detecting potentially curable recurrent disease. Physician visits were useful only in.the evaluation of symptoms; a routine physician examination had no added benefit.