乳腺活检或手术前补充MRI检查的经济可行性评价  

Cost-Effectiveness of Supplementary MRI Prior to Biopsy or Surgical Procedure for Breast Diseases

作　　者：雷小勇 姚明 李梦露[3] 高文文 程流泉[3] LEI Xiaoyong;YAO Ming;LI Menglu;GAO Wenwen;CHENG Liuquan(Department of Radiology,Sixth Medical Center of Chinese PLA General Hospital,Beijing 100048,China;不详)

机构地区：[1]宿松县人民医院放射科,安徽宿松246501 [2]北京市顺义医院放射科,北京101399 [3]解放军总医院第六医学中心放射科,北京100048

出　　处：《中国医学影像学杂志》2023年第8期828-832,共5页Chinese Journal of Medical Imaging

摘　　要：目的 以每个拟活检或手术前的乳腺疾病患者均行乳腺MRI筛选作为假设,从卫生经济学角度验证通过MRI筛查减免或节省的活检或手术费用能否支付乳腺MRI费用。资料与方法 选取2021年6月—2022年4月于北京市顺义医院和安徽省宿松县人民医院完成活检或手术的乳腺疾病患者271例,使用44例活检或术前行MRI检查者计算乳腺MRI的诊断效能,并依次虚拟计算227例无MRI检查者,根据组织病理、影像诊断和患者意愿分为可活检手术组和无需活检手术组(BSU)。按照实际医疗收费标准,计算和验证研究组患者在活检或手术前利用MRI检查划归为BSU所节省的医疗费用是否高于增加的MRI支出。结果 227例研究组中191例在组织病理水平判断为BSU,其医疗费用为2 890 227元;以研究组获得的MRI假阴性率为25%,在影像诊断水平以MRI的阴性预测值75%计算,BSU患者的医疗费用为1 715 061元;以影像诊断良性仍有50%患者主观选择活检或手术,BSU的医疗费用为857 530元,均高于227个乳腺MRI的费用283 750元。结论 如果在乳腺活检或手术前补充MRI检查来排除不必要的活检或手术,其节省的费用足以支付增加的MRI费用,并且可以有效减少不必要的有创处理。Purpose To test the hypothesis that if a supplementary breast MRI is added prior to the biopsy or surgical procedures,the saved medical payment for screen-out biopsy or surgery will be enough to cover all MRI examinations.Materials and Methods Two hundred and seventy-one consecutive patients with biopsy or surgical procedures from the People's Hospital of SuSong County and Beijing Shunyi Hospital during June 2021 to April 2022 were retrospectively enrolled.A total of 44 cases with breast MRI examinations were taken as the reference to get the MRI diagnostic efficiencies for the virtual calculation of the other 227 cases without breast MRI.The study was conducted at three hypothesized levels,histopathological level,imaging level and patient-will levels,to determine whether the patients and its lesions was biopsy or surgery acceptable or biopsy or surgery unnecessary(BSU).The saved payment from BSU by MRI screen-out and the payment for MRI examination was compared.Results Of the 227 patients in the research group,191 patients re-defined as BSU at the histopathological level and their payment was 2890227 RMB.At the imaging level,taken MRI negative predictive value as 75%,the payment for BSU was 1715061 RMB.At the patient-will level,taken 50%of the imaging benign were decided by patients,the payment for BSU was 857530 RMB.While the payment for the 227 breast MRI was 283750 RMB and was less than the least saved from BSU.Conclusion It is confirmed that if a supplementary breast MRI is added prior to the biopsy or surgical procedures,the saved medical payment for screen-out biopsy or surgery is enough to cover all MRI examinations and it was cost-effective.

关 键 词：乳腺疾病 磁共振成像 卫生经济 效能 

分 类 号：R737.9[医药卫生—肿瘤] R445.2[医药卫生—临床医学]