半月板撕裂临床影像学诊断策略的经济学评价  

Economic evaluation of the clinical imageology diagnostic strategies of meniscus tear

作　　者：闫锐[1] 宁宁[2] 冀贞浩[3] 杨镇[4] 许鹏[4] 郭佑民[2] 

机构地区：[1]西安交通大学医学院附属西安市中心医院放射科,陕西西安710003 [2]西安交通大学医学院第一附属医院医学影像科 [3]西安交通大学医学院流行病学教研室 [4]西安市红十字会医院外科

出　　处：《实用放射学杂志》2012年第9期1429-1432,1447,共5页Journal of Practical Radiology

摘　　要：目的 评价以病史为基础实用的半月板撕裂诊断策略（交锁、麦氏征联合MRI策略）的成本效果.方法 制定半月板撕裂的诊断策略,运用决策分析（TreeAge）软件对其进行成本效果分析.结果 基于本研究可疑半月板撕裂72.1%的发生率,可疑半月板撕裂的3个诊断策略中MRI策略的成本效果比稍差,但诊断准确率最高（0.893312）;交锁、麦氏征联合MRI策略不仅成本效果比很好,诊断准确率也很高（0.858 826）;临床症状和体征策略的成本效果比最好,但诊断准确率太低（0.664 329）.增量成本-效果分析,以临床症状和体征策略为参照策略,交锁、麦氏征联合MRI策略每准确诊断1例患者增加的成本是2 663.28元人民币,MRI策略每准确诊断1例患者增加的成本是6 524.39元人民币.单因素敏感度分析时,模型结果相对稳定.结论 交锁、麦氏征联合MRI策略（交锁阳性和或麦氏征阳性的患者进一步行MRI检查）是关节镜手术证实的半月板撕裂最符合成本-效果的诊断策略.Objective To evaluate the cost effectiveness of a history-based pragmatic diagnostic strategy for meniscus tears. Methods A practical history based diagnostic strategy and other possible diagnostic strategies for meniscus tears were made. For theeco nomic analysis, a decision tree was developed and cost effectiveness analyses were performed using decision analysis software DATA 3.5 （TreeAge Software, Inc.）. Results At the baseline prevalence of 72. 1% of suspected meniscal tears, the MRI strategy resul ted in a significant high diagnostic accuracy （0. 893 312 ）, despite a less cost effective approach; The locking and McMurray＇s test ＆ MRI strategy also resulted in a significant high diagnostic accuracy （0. 858 826）, was more cost effective approach. The clinical symptoms and signs strategy had the lowest diagnostic accuracy （0.66.1 329）, despite the most cost-effectiveapproach. For the costeffectiveness analysis, of all the patient groups evaluated, the locking and McMurray＇s test ~. MRI strategy was more cost-effective （ICER 2 663.28 RMB Yuan per diagnostic accuracy）. In contrast, the MRI strategy was less cost-effective strategy （ICER 6 521.39 RMB Yuan per diagnostic accuracy）. Sensitivity analysis showed that the results of the model were relatively robust. Conclusion For the conditions evaluated, the locking and McMurray＇s test ＆ MRI proposal appears to yield diagnostic accuracy at an acceptable cost.

关 键 词：半月板撕裂 诊断策略 决策树 成本-效果分析 

分 类 号：R684[医药卫生—骨科学] R814.4[医药卫生—外科学]