OBJECTIVES:Cost-effectiveness analysis of three diagnostic imaging strategies for the assessment of aortoiliac and femoropopliteal arteries in patients with peripheral arterial occlusive disease. The strategies were: angiography as the reference strategy, duplex scanning (DS) plus supplementary angiography (S1) and DS plus confirmative angiography (S2). DESIGN, MATERIALS AND METHODS:A decision model was built with sensitivity and specificity data from literature, supplemented with prospective hospital cost data in Euro (euro). The probability of correctly identifying the status of a lesion was taken as the primary outcome. We compared strategies by assessing the extra costs per additional correctly identified case. RESULTS:Assuming no false positive or false negative results, angiography is the most effective strategy if the prevalence of significant obstructive lesions in the aortoiliac and femoropopliteal tract exceeds 70%, or if the sensitivity of duplex scanning is lower than 83%. In case of lower prevalence, strategy S1 becomes equally or even more effective than angiography. At a prevalence of 75%, performing angiography costs euro 8443 per extra correctly identified case compared with strategy S1. CONCLUSIONS:In most situations angiography is more effective than diagnostic strategy S1. However, if society is unwilling to pay more than euro 8443 for knowing a patient's disease status, diagnostic strategy S1 is a cost-effective alternative to angiography, especially at lower prevalence values.

译文

目的:评估三种诊断性成像策略评估外周动脉闭塞性疾病的主动脉和股pop动脉的成本效益分析。这些策略是:作为参考策略的血管造影,双重扫描(DS)加上辅助血管造影(S1)和DS加上确认性血管造影(S2)。
设计,材料和方法:建立决策模型,其中包含来自文献的敏感性和特异性数据,并补充以欧元(欧元)计算的前瞻性医院成本数据。正确识别病变状态的可能性被视为主要结局。我们通过评估每个其他正确确定的案例的额外成本来比较策略。
结果:假设没有假阳性或假阴性结果,如果主动脉和股pop道的严重阻塞性病变的患病率超过70%,或者双重扫描的敏感性低于83%,则血管造影术是最有效的策略。在患病率较低的情况下,策略S1与血管造影术等效或什至更有效。与策略S1相比,在75%的患病率下,对每个额外正确识别的病例进行血管造影的费用为8443欧元。
结论:在大多数情况下,血管造影比诊断策略S1更有效。但是,如果社会不愿意为了解患者的疾病状况付出多于8443欧元的费用,则诊断策略S1是血管造影术的一种经济有效的替代方法,尤其是在较低的患病率时。

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