| Objective:To evaluate the validity and cost-effectiveness ratio of 256-layer spiral computed tomography (256CTA) and selective coronary angiography (SCAG) in detection of coronary atherosclerotic heart disease (CAD) to provide suggestion for selective validity and cheap way in clinic diagnosis and hospitals administrative departments.Methods:The respective study was used to analyze the cost-effectiveness ratio (C/E) of the two kinds of inspection programs. Suspected CAD hospitalized patients who were selected from July-December 2009 to 2010 January-June of The Second Affiliated Hospital of Kunming Medical College. Data related to different index of diagnosis value system to evaluate to the validity of 256MSCT and SCAG. All the highly suspected CAD hospitalized patients divided two groups:256MSCT and SCAG group. Indirect cost was calculated in an attempt to quantify the economic impact of CAD. A decision trees model was used to make a decision analysis in the cost-effectiveness ratio of two strategic of coronary atherosclerotic heart disease.Results:(1) All in hospitalized patients with coronary heart disease in the largest proportion of workers (30.6%). In medical security means, the highest proportion of social medical system(50.1%).The new rural cooperative medical proportion is 9.6%, Sixty years old age has the highest percentage rate, man than women (male 60.4%, female 39.6%), most of cases suffered from the hypertension, hyperlipiemia, diabetes and so on. There is no difference of the age, sex, and the past disease history. (2)For the diagnosis of coronary heart disease,256MSCT diagnosis accuracy index and the corresponding indexes SCAG,256MSCT negative diagnosis is 28.2%, the positive rate of diagnosis is 81.7% of SCAG, negative rate with the 256MSCT 26.1%,the positive rate of diagnosis is 74.1% of 256MSCT,in terms of diagnostic accuracy, two group diagnosis validity have a high degree of agreement ratio. Two groups has a significant level, P<0.05.(3)The total cost of the 256MSCT and SCAG was respectively,796000,642000 yuan (total cost of 612 cases 6,638,424.00 yuan RMB for CAD diagnosis for patients).The increased cost and effect between MSCT and SCAG was 2204 yuan and 9020 yuan RMB by incremental analysis, The ratio of 1.32. According to the calculation, the benefits of 256MSCT in detection CAD patients was higher than of SCAG and the medical costs could save 28.2% compared with SCAG. (4) Using drugs on economics principle, sensitivity analysis shows that the research different was different by the parameters of the model. the results 256 layer sensitivity analysis of sensitivity titer spiral CT for 1960 yuan RMB/cases, the SCAG for 2445 yuan RMB/cases, and 256 layer spiral CT within the scope of certain and change does not affect the results of this study, in perspective of C/E, the lowest cost of spiral CT layer could be optimization scheme for diagnosis of CAD.Conclusion:(1)SCAG has better diagnosis accuracy than 256MSCT in terms of the validity identified the more accurate diagnosis of value, so far clinically recognized as verified the "gold standard" status. But for individual in hospital patients, comprehensive consideration of the expenses and diagnosis result, 256MSCT has better cost-effectiveness ratio than SCAG, so for hypertensiveâ…¢, high blood, hyperlipemia typeâ…¡diabetes, high-risk groups, we proposal diagnosis first by 256MSCT.But considering 256MSCT has a better C/E than SCAG.So we suggest 256MCT prior screening diagnosis preferred then confirmed the SCAG diagnosis of CAD patients. (2)We Should combine 256 layer spiral CT unique advantages such as the safety,cheap, patients compliance to popular 256 MSCT the application of the clinical application for its vascular imaging advantage,256 MSCT examination insurance projects would put into the scope of the wider coverage of social medical system, especially the New rural Cooperative Medical System, make the current medical treatment to ensure a system to quickly adapt to the socialist productive forces development level to meet the people health demands. |
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