胶囊内镜、双气囊内镜单独与联合运用对小肠疾病诊断效力的卫生经济学评价  

Clinical and health economic evaluation of the capsule endoscope(CE) or/and double-balloon enteroscopy(DBE) in diagnosis of intestine disease

作　　者：万苹[1] 范红[1] 郭强[1] 周雁[1] 汤敏[1] 赵琳[1] 王骊[1] 

机构地区：[1]云南省第一人民医院消化科,云南昆明650032

出　　处：《中国内镜杂志》2011年第2期151-156,共6页China Journal of Endoscopy

摘　　要：目的评价单独应用胶囊内镜(CE)、双气囊内镜(DBE)及两种内镜联合使用在小肠疾病中的诊断价值;对CE、DBE和CE联合DBE进行卫生经济学评价,探讨诊断小肠疾病最经济的方法。方法共对241例疑有小肠疾病的患者应用单独CE、DBE以及CE联合DBE的检查方法进行研究。记录CE和DBE检查的敏感性、特异性、准确度、阳性似然比与阴性似然比。以活检组织和手术大体标本的病理学结果为确诊标准,评价CE、DBE单独与联合运用在小肠疾病中的诊断价值,进行卫生经济学评价。结果 CE的敏感度为:81.73%,特异度为:56.52%,准确度为:77.16%,阳性似然比为1:.87,阴性似然比为0:.32;DBE敏感度为:85.86%,特异度为:63.63%,准确度为:81.57%,阳性似然比为:2.36,阴性似然比为:0.22;CE+DBE敏感度为:90.56%,特异度为:78.57%,准确度为:88.05%,阳性似然比为:4.22,阴性似然比为:0.12。CE、DBE和CE+DBE的成本-效果比分别为:4 781.17元/人、4 329.1元/人和4 950.94元/人。CE联合DBE与CE相比,每多诊断出1例小肠病变需增加成本12 280元/人,但可获得效益为17 082.2元/人,成本-效益比是1.39,净效益为24 011元/人。结论对于CE检查阴性的患者再进行DBE检查可提高诊断效果。成本-效果和成本-效益分析表明CE联合DBE是一项既有临床意义、有具有卫生经济学意义的诊断方法。【Objective】 To evaluate the clinical value of the capsule endoscope（CE） and double-balloon enteroscopy（DBE） in diagnosis of intestine disease.To analysis the cost/benefit of CE or/and DBE.【Methods】 241 patients with digestive tract disease of unknown origin from March 2005 to October 2009 were performed CE or/and DBE.The successful rate was recorded in terms of the sensitivity,specificity,accuracy,positive likelihood ratio,negative likelihood ratio CE,DBE and CE combining with DBE.3 diagnostic methods with cost-effect analysis were evaluated and the cost/benefit with incremental analysis was calculated by comparing CE、DBE and CE combining with DBE.Also the cost and benefit of each additional diagnosis of intestine disease were calculated by CE＋DBE.【Results】 CE sensitivity： 81.73%,specificity： 56.52%,accuracy： 77.16%,Positive likelihood ratio：1.87,Negative likelihood ratio： 0.32;DBE sensitivity： 85.86%,specificity： 63.63%,accuracy： 81.57%,Positive likelihood ratio： 2.36,Negative likelihood ratio： 0.22;CE＋DBE sensitivity： 90.56%,specificity： 78.57%,accuracy： 88.05%,Positive likelihood ratio： 4.22,Negative likelihood ratio： 0.12.CE,DBE and CE＋DBE cost/effeteness is 4781.17 RMB,4329.1 RMB and 4950.94 RMB respectively.Comparing with CE alone,each additional diagnosis of intestine disease by CE＋DBE increased by 12280 RMB,but gained the benefit of 17082.2 RMB,and net benefit was 24011 RMB.【Conclusion】 DBE can increase the accuracy of diagnosing intestine disease for whom can not be diagnosed by CE.The cost/effect shows that CE combining with DBE is not only a clinical valuable method but also an economic way in diagnosing intestine disease.

关 键 词：胶囊内镜 双气囊电子小肠镜 小肠疾病 卫生经济学评价 

分 类 号：R443.7[医药卫生—诊断学]