核医学中的经济学评价研究：标准化的必要性

摘要(中文译文)

发表经济学评价的指南要求说明分析的经济重要性、所采用的观点，以及至少两种备选方案或干预措施的说明、经济学评价的形式、结果指标、成本核算方法、时间范围以及成本与效益的时间调整（例如通过贴现因子），并考虑不确定性（例如通过实施敏感性分析）。决策分析可以基于临床试验数据、回顾性或行政数据库，或基于模型。结果指标的选择是经济学评价中的关键问题。在成本效果分析中，效益通常以自然单位衡量。这是核医学中最常使用的经济学评价形式。该领域研究中应用的效果终点包括避免的操作、启动的操作、心脏事件、生存概率、发病率、生活质量和延长或失败的外科手术。在其他情况下，使用了替代终点，如检测到的转移、分期、活力或肿瘤反应。然而，这极大地限制了成本效果的可比性，因为无法获得健康结局改变的证明。效用指标如QALYs（质量调整生命年）迄今仅应用于决策树分析。本文介绍了核医学中经济学评价研究的有用实例，包括氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）用于非小细胞肺癌术前分期、FDG-PET用于鉴别不确定的孤立性肺结节、生长抑素受体闪烁显像用于检测类癌肿瘤转移、常规术前司他比闪烁显像用于甲状旁腺腺瘤患者、周期性测量促甲状腺激素用于检测轻度甲状腺功能减退、包含肺扫描的诊断算法用于疑似肺栓塞患者、心肌灌注显像作为冠心病患者的增量预后因素，以及放射性碘作为Graves甲亢和毒性结节性甲状腺肿一线治疗的应用。应在多学科框架内开展进一步的效果或效用评价，以确保核医学操作被纳入一般管理指南。

Abstract

The guidelines for publishing economic evaluations require a statement of the economic importance of the analysis and the viewpoint from which it has been carried out, as well as specification of at least two alternative programmes or interventions, the form of economic evaluation, the outcome measure, the method of costing, the time horizon and adjustment for timing of costs and benefits (e.g. by a discount factor), and the allowance for uncertainties (e.g. by implementation of a sensitivity analysis). The decision analysis can be based on clinical trial data, on retrospective or administrative databases, or on modelling. The choice of outcome measures is the key issue in an economic evaluation. In cost-effectiveness analysis, benefits are usually measured in natural units. This is the form of economic evaluation most frequently used in nuclear medicine. Endpoints of effectiveness applied in studies in this field have been procedures avoided, procedures initiated, cardiac events, survival probability, morbidity, quality of life and protracted or failed surgical procedures. In other instances, surrogate endpoints have been used such as metastases detected, staging, viability or tumour response. This, however, limits comparability of cost-effectiveness considerably, as proof of a change in the health outcome cannot be obtained. Measures of utility such as QALYs (quality-adjusted life years) have so far only been applied for decision tree analysis. Useful examples of economic evaluation studies in nuclear medicine are presented here for fluorodeoxyglucose positron emission tomography (FDG-PET) in the preoperative staging of non-small cell lung cancer, for FDG-PET in differentiating indeterminate solitary pulmonary nodules, for somatostatin receptor scintigraphy in detecting metastases of carcinoid tumours, for routine preoperative scintigraphy with sestamibi in patients with parathyroid adenoma, for periodic measurement of thyroid-stimulating hormone in detecting mild thyroid failure, for diagnostic algorithms including a lung scan in patients with suspected pulmonary embolism, for myocardial perfusion imaging as an incremental prognostic factor in patients with coronary artery disease, and for the use of radioiodine as first-line therapy of Graves' hyperthyroidism and of toxic nodular goitres. Further evaluations of effectiveness or utility should be carried out within a multidisciplinary framework to ensure that nuclear medical procedures are included in the general management guidelines.

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