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Accuracy, Risk and the Intrinsic Value of Diagnostic Imaging. A Review of the Cost-utility Literature

机译：准确性，风险和诊断成像的内在价值。 审查成本效用文献

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摘要

Rationale and Objectives: The aim of this study was to systematically review the reporting of the value of imaging unrelated to treatment consequences and test characteristics in all imaging-related published cost-utility analyses (CUAs) in the medical literature. Materials and Methods: All CUAs published between 1976 and 2008 evaluating diagnostic imaging technologies contained in the CEA Registry, a publicly available comprehensive database of health related CUAs, were screened. Publication characteristics, imaging modality, and the inclusion of test characteristics including accuracy, costs, risks, and the potential value unrelated to treatment consequences (eg, reassurance or anxiety) were assessed. Results: Ninety-six published CUAs evaluating 155 different imaging technologies were included in the final sample; 27 studies were published in imaging-specialized journals. Fifty-two studies (54%) evaluated the performance of a single imaging modality, while 44 studies (46%) compared two or more different imaging modalities. The most common areas of interest were cardiovascular (45%) and neuroradiology (17%). Forty-two technologies (27%) concerned ultrasound, while 34 (22%) concerned magnetic resonance. Seventy-nine (51%) technologies used ionizing radiation. Test accuracy was reported or calculated for 90% (n = 133 and n = 5, respectively) and assumed perfect (reference test or gold-standard test without alternative testing strategy to capture false-negatives and false-positives) for 8% (n = 12) of technologies. Only 22 studies (23%) assessing 40 imaging technologies (26%) considered inconclusive or indeterminate results. The risk of testing was reported for 32 imaging technologies (21%). Fifteen studies (16%) considered the value of diagnostic imaging unrelated to treatment. Four studies incorporated it as quality-of-life adjustments, while 10 studies mentioned it only in their discussions or as a limitation. Conclusions: The intrinsic value of imaging (the value of imaging unrelated to treatment) has not been appropriately defined or incorporated in the existing cost-utility literature, which could be due to a lack of evidence on the issue. Thus, more research is needed on metrics for a more comprehensive evaluation of diagnostic imaging. Similarly, the incorporation of variations in imaging tests accuracy, inconclusive results and associated risks has lacked uniformity in the cost-utility literature. Acknowledgment of these characteristics in future cost-utility publications will enhance their value and provide results that more closely resemble routine clinical practice.
机译：理由和目标：本研究的目的是系统地审查与医学文献中所有影像相关的公布的成本实用程序分析（CUA）的治疗后果和测试特征无关的成像的报告。材料和方法：筛选了1976年至2008年间评估了CEA登记中心中包含的诊断成像技术的CUA，筛选了一项公开可用的健康相关CUA数据库。出版物特征，成像模态和包含测试特征，包括准确性，成本，风险和与治疗后果无关的潜在价值（例如，保证或焦虑）进行评估。结果：最终样品中包含九十六发布的CUA评估155种不同的成像技术; 27项在专业的期刊上发表了研究。五十二项研究（54％）评估了单一成像模态的性能，而44项研究（46％）比较了两种或更多种不同的成像方式。最常见的感兴趣区域是心血管（45％）和神经加理学（17％）。四十两项技术（27％）有关超声，而34（22％）有关磁共振。七十九（51％）技术使用电离辐射。报告测试精度或分别计算90％（n = 133和n = 5），并假设完美（参考测试或金标准测试，没有替代测试策略以捕获假否定和假阳性）持续8％（n = 12）技术。只有22项研究（23％）评估40种成像技术（26％）被认为是不确定的或不确定的结果。报告了32种成像技术（21％）的测试风险。十五项研究（16％）认为诊断成像与治疗无关的价值。四项研究作为生活质量调整，而10项研究仅在其讨论中或作为限制。结论：成像的内在价值（与治疗无关的成像价值）尚未适当地定义或纳入现有的成本效用文献中，这可能是由于缺乏关于该问题的证据。因此，在诊断成像的更全面评估的度量标准中需要更多研究。类似地，在成本效用文献中缺乏成像测试精度，不确定结果和相关风险的变化缺乏均匀性。对未来的成本型公开的这些特征的确认将提高其价值，并提供更密切的常规临床实践的结果。

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  • 来源
    《Academic radiology》 |2012年第5期|共8页
  • 作者

    OteroH.J.; FangC.H.; SekarM.; WardR.J.; NeumannP.J.;

  • 作者单位

    Department of Radiology Tufts Medical Center 800 Washington Street Boston MA 02111 United;

    Center for the Evaluation of Value and Risk in Health The Inst. for Clinical Research and Health;

    Department of Radiology Tufts Medical Center 800 Washington Street Boston MA 02111 United;

    Department of Radiology Tufts Medical Center 800 Washington Street Boston MA 02111 United;

    Center for the Evaluation of Value and Risk in Health The Inst. for Clinical Research and Health;

  • 收录信息
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 放射医学;
  • 关键词

    Cost-effectiveness; Diagnostic imaging; risk; Sensitivity; Specificity;

    机译：成本效益;诊断成像;风险;敏感性;特异性;

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