胶囊内镜诊断小肠疾病的卫生技术评估  

Capsule Endoscopy in Diagnosis of Small Bowel Diseases: An Health Technology Assessment

作　　者：李向莲[1] 沈建通[1] 李幼平[1] 唐承薇[2] 李萃萃[1] 喻佳洁[1] 王应强[1] 杨宗霞[1] 师成虎[1] 孙鑫[1] 黄丽彬[2] 代表中国循证医学中心快速卫生技术评估课题组 

机构地区：[1]四川大学华西医院中国循证医学中心,成都610041 [2]四川大学华西医院消化内科,成都610041

出　　处：《中国循证医学杂志》2014年第5期541-553,共13页Chinese Journal of Evidence-based Medicine

基　　金：美国中华医学基金会卫生政策循证研究合作项目,编号:12-095~~

摘　　要：目的胶囊内镜（capsuleendoscopy，cE）已被多国广泛用于诊断小肠疾病，为将cE纳入我国医保目录、加大向基层医院示范推广力度，政府急需高质量证据帮助决策。本研究旨在全面了解全球胶囊内镜诊断小肠疾病的有效性、安全性、适用性和经济性，为政府卫生政策制定者提供当前可得的最佳决策证据。方法计算机检索TheCochraneLibrary（2013年第8期）、PubMed、EMbase、INAHTA、VIP、CBM、CNKI和WanFangData。按照纳入与排除标准筛选文献、提取资料和评价质量，然后综合分析得出结论。结果最终共纳入32个研究，其中卫生技术评估（HTA）、系统评价（SR）／Meta分析、随机对照试验（RCT）、指南和经济学研究分别为4、11、2、5和10个。其结果均显示，CE检H{率高于其他多项相关传统技术，主要不良事件为胶囊滞留（O．7％～3．0％），与指南推荐一敛。，经济学分析结果显示，与其他技术相比，CE作为首选可明显降低潜在成本，且门诊患者潜在成本降低最届著。结论①CE诊断小肠疾病优势明显且较安全，比同类技术更能降低潜在成本。但使用存在一定局限性，仍需高质量证据证实．．②建议政府在批准医院引进CE时，需综合考虑当地疾病负担、临床需求、支付能力和人员配套等因索。同时须强渊进…步规范化培训操作医师，减少因医务人员个人技术原因造成的经济损失。Objective Capsule endoscopy （CE） has been widely used in the diagnosis of small bowel disease （SBD） in the world. To bring CE into the national health insurance directory, and intensify its popularization in primary hospitals, the government needs high quality health technology assessment （HTA） evidence for decision making. This study was aimed to comprehensively evaluate the effectiveness, safety, applicability and economics of CE in the diagnosis of SBD based on global review, to providing the best currently-available evidence for decision making. Methods We electronically searched The Cochrane Library （Issue 8, September 2013）, PubMed, EMbase, INAHTA, V1P, CBM, CNKI and WanFang Data. We screened studies, extracted data, and evaluated quality independently, according to inclusion and exclusion criteria; and then we made final conclusion after comprehensive analysis. Results We finally included 4 HTAs, 11 systematic reviews （SRs）/Meta-analyses, 2 randomized controlled trials （RCTs）, 5 guidelines, and 10 economics stud- ies for assessment. The results of HTAs, SRs/meta-analyses and RCTs all showed that, the disease detection rate of CE was higher than that of many other traditional technologies, and that the main adverse event for CE was retention （0.7% to 3.0%）, which were consistent with those of the guidelines＇ recommendations. Besides, the comprehensive results of economics studies showed the superiority of CE compared with other technologies. As the first choice, CE could significantly decrease potential costs, especially when used in outpatients. Conclusion a） Compared with similar technologies, CE indeed has advantages in diagnostic yield, safety and potential costs in the diagnosis of SBD. However, its application has certain limitations, which still needs to be verified by more high quality evidence about CE diagnosis accuracy, b） It is suggested that, when the government approves the introduction of CE to hospitals, many factors must be considered, such as local dise

关 键 词：胶囊内镜 小肠疾病 诊断 卫生技术评估 

分 类 号：R574.5[医药卫生—消化系统]