骨髓活检:CT,光学还是没有成像指导是最具成本效益的策略?
Soterios Gyftopoulos1, Madalena Da Silva Cardoso2, Jim S Wu3
1Department of Radiology, NYU Langone Health, New York, New York, USA (S.G., M.D.S.C.); Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA (S.G.).
对于疑似多发性髓瘤 (MM) 的患者,非成像骨髓活检是最具成本效益的策略. 与成像指导方法相比,这种方法提供了最高的净货币收益和最低的总体成本.
科学领域:
- 卫生经济学 卫生经济学
- 在瘤学瘤学.
- 医疗成像医学成像
背景情况:
- 多发性骨髓瘤 (MM) 的诊断依赖于骨髓活检.
- 评估不同活检指导技术的成本效益对于医疗保健资源分配至关重要.
研究的目的:
- 为了确定骨盆骨髓核心活检的最具成本效益的策略.
- 比较计算机断层扫描 (CT) 指导,光学指导和无成像 (基于基准) 活检技术.
主要方法:
- 从医疗保健系统的角度使用决策分析模型.
- 模型输入包括成本,公用事业,以及来自文学和专家意见的概率.
- 质量调整寿命年 (QALY) 和每QALY支付10万美元的愿意支付门是主要结果.
主要成果:
- 基于无成像的活检是最具成本效益的策略,产生了最高的净货币效益 (4218美元) 和最低的成本 (92.17美元).
- CT导向活检的增量成本效益比为334,043美元,超过了支付意愿的门.
- 概率敏感性分析证实,非成像活检在100%的模拟中是最具成本效益的.
结论:
- 基于非成像的骨髓活检是疑似多发性骨髓瘤 (MM) 的患者最具成本效益的策略.
- 虽然一般偏好图像指导,但对于复杂的解剖学可能是必要的.
- 建议考虑加强非成像指导活检的患者支持服务.
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