非侵入性心脏诊断测试成本的比较 - 一项基于人口的研究
Idan Roifman1, Anna Chu2, Peter C Austin3
1Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada.
概括
对胸痛的非侵入性心脏诊断测试 (NIT) 降低了下游成本12%. 分级运动压力测试和压力心电回声是最具成本效益的NIT,而CCTA和MPI增加了成本.
科学领域:
- 心脏病学 心脏病学
- 卫生经济学 卫生经济学
- 诊断成像 诊断成像 诊断成像
背景情况:
- 冠状动脉疾病的非侵入性心脏诊断测试 (NIT) 昂贵且可能被过度使用.
- 对比不同NIT策略的下游成本对于医疗保健规划至关重要.
研究的目的:
- 为了比较四种NIT策略的下游成本 (分级运动压力测试[GXT],压力心声学,心脏计算机断层扫描血管学[CCTA],心肌输液成像[MPI]) 与没有测试的患者对胸痛进行评估.
主要方法:
- 利用来自加拿大安大略省的基于人口的行政和临床数据.
- 在接受GXT,压力心声学,CCTA,MPI或没有测试的患者中比较下游成本.
- 采用了log-gamma通用线性模型来分析偏斜的医疗保健成本数据,调整共变量.
主要成果:
- 与没有测试相比,任何NIT与下游1年平均成本减少12%有关.
- 分级运动压力测试 (GXT) 和压力心声图与较低的下游成本有关.
- 心肌输液成像 (MPI) 和心脏计算机断层扫描血管造影 (CCTA) 与更高的下游成本有关.
结论:
- 超过200万胸痛患者的非侵入性测试与下游成本下降12%有关.
- GXT和压力心声回声显示了最低的下游成本.
- 与没有测试相比,CCTA和MPI导致下游成本更高,为临床决策提供了信息.
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