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多发性骨髓瘤:最具成本效益的成像策略是什么,以初步检测骨损伤?

Soterios Gyftopoulos^1,2, Arnau Hanly³, Naveen Subhas⁴

¹Department of Radiology, NYU Langone Health, New York, NY, USA.

Skeletal radiology

|October 28, 2024

概括

低剂量计算机断层扫描 (LDCT) 和具有扩散的全身磁共振成像 (WBMRI) 是用于检测多发性骨髓瘤骨损伤的具有成本效益的方法. 最好的选择取决于患者疾病进展的风险因素.

科学领域:

医疗成像医学成像
卫生经济学卫生经济学
在瘤学瘤学.

背景情况:

多发性骨髓瘤 (MM) 诊断依赖于检测骨损伤.
确定具有成本效益的成像策略对于早期MM检测至关重要.
具有未确定的意义单克隆性甘马病 (MGUS) 的患者有不同的进展到MM的风险.

研究的目的:

评估不同成像方法的成本效益,以初步检测MM定义的骨病变.
为了比较骨调查 (SS),低剂量计算机断层扫描 (LDCT),正子辐射计算机断层扫描 (PETCT) 和全身磁共振成像 (WBMRI) 具有和没有扩散 (DIFF).

主要方法:

从医疗保健系统的角度使用马尔科夫模型.
模型输入来自于全面的文献综述.
费用为2024美元,有效性为质量调整后的寿命年 (QALYs),20年时间内的支付意愿 (WTP) 门为10万美元/QALY.
分析包括蒙特卡洛微模拟和概率灵敏度分析 (PSA).

主要成果:

根据MM进展的患者风险因素的数量,成本效益有所不同.
对于没有风险因素的患者,LDCT是最具成本效益的 (净货币收益为1,030,913.57美元).
对于具有1-2个危险因素的患者,WBMRI + DIFF是最具成本效益的 (分别为802,637.30美元和664,430.36美元).
在所有场景中,WBMRI和PETCT占主导地位.

结论:

建议LDCT和WBMRI + DIFF作为初始MM诊断中最具成本效益的成像策略.
最佳的选择取决于个体患者从MGUS进展到骨髓瘤的风险因素.

关键词:

对成本效益的分析.磁共振成像技术磁共振成像技术多发性骨髓瘤是一种多发性骨髓瘤.定子发射断层扫描 (PET) 是一种定子发射断层扫描.电脑断层扫描X射线扫描

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