围手术诊断工具对临床结果和甲状腺外科手术的成本效益的影响:基于决策模型的分析
Daniel Bátora1,2, Rowan Iskandar3,4, Juerg Gertsch1
1Institute of Biochemistry and Molecular Medicine, University of Bern, Bern, Switzerland.
BMJ open
|September 6, 2024
概括
四维CT (4D-CT) 是治疗原发性副甲状腺症 (PHPT) 的最具成本效益的手术前成像. 在手术内对甲状腺激素 (ioPTH) 监测不具有成本效益,但在使用特定标准时可以最大限度地减少并发症.
科学领域:
- 内分泌学 在内分泌学.
- 手术瘤学手术瘤学
- 卫生经济学 卫生经济学
背景情况:
- 手术前和手术后的诊断工具显著影响了原发性副甲状腺症 (PHPT) 的外科治疗.
- 目前的诊断工具在分类PHPT原因,如单独腺瘤和多腺体疾病时显示出不同的性能.
- 对于PHPT患者的最佳术后管理策略缺乏共识.
研究的目的:
- 估计和比较各种手术前成像方法的成本效益和PHPT的手术内甲状腺激素 (ioPTH) 监测标准.
- 在21年的时间范围内评估临床结果和经济效益.
主要方法:
- 开发了一个决策树模型来模拟临床结果和成本效益.
- 该模型包含了手术前成像 (4D-CT,超声波,99mTc-SPECT/CT,18F-胆PET) 和ioPTH监测标准 (迈阿密,维也纳).
- 进行了敏感性和不确定性分析,以评估模型的稳定性.
主要成果:
- 四维CT (4D-CT) 成为最便宜的手术前策略 (10,276美元,15,333个QALY).
- 18F-胆PET是具有成本效益的 (416美元). 超声波和99mTc-SPECT/CT是主要的策略.
- 根据维也纳标准对ioPTH的监测减少了重新手术,但由于增加了双边部探索,这并非具有成本效益.
结论:
- 4D-CT是最具成本效益的方法,用于在单独腺瘤和多腺体疾病的手术前定位.
- 总体而言,ioPTH监控的成本效益并不高.
- 为了最大限度地减少并发症,建议在怀疑单独腺瘤时使用迈阿密标准,在怀疑多腺体疾病时使用维也纳标准.
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