腹腔镜-费用效果分析全面2001-4-24.doc

PAGE 1 PAGE 6 疑难性腹部疾病诊断的费用效果分析 周曾芬1 陈世耀2 王吉耀2 1 昆医附一院消化内科 2 上海医科大学附属中山医院消化内科 摘要 目的 研究腹腔镜检查在诊断疑难性腹部疾病中的效率（即费用--效果）。 方法 将 31例疑难性腹部疾病的诊断方法分四组：基础组，腹腔穿刺腹水检查和 B超检查；增强 CT组，增强CT检查；腹腔镜组，腹腔镜检查；联合组，以上方法联合检查。统计各组的确诊率；以云南省三级甲等医院收费标准，计算各组每确诊 1例所需要的平均费用；与基础组相比后三组每增加 1例确诊所需要增加的费用；并作敏感性分析。 结果 基础组、增强CT组、腹腔镜组和联合组的确诊率分别为 2/31、 6/31、 30/31和 30/31；每确诊 1例平均费用分别为3348.90元、4511.43元、1455.49元、2124.14元；与基础组相比，每增加 1例确诊，后三组所需要增加的费用分别为5092.70元、1320.25元、2036.65元。可见，腹腔镜组和联合组明显优于增强CT组，而且以腹腔镜组为最优。敏感性分析仍然支持本研究结果。 结论 疑难性腹部疾病进行腹腔镜检查可尽早明确诊断、及时治疗，其成本费用最少。 关键词: 腹腔镜检查 腹腔穿刺检查 影像学检查 疑难病 费用效果分析 中国图书分类号: 573.2 A cost-effectiveness study of diagnosis by laparascopy of difficult and complicated abdominal diseases Zhou zengfen Lu shuan Qin xinglu Cui rong Department of Gastroenterolong，the First Affilia Hospital of Kunming Medical College，Kunming，650032 Chen shiyao Wang jiyao Department of Gastroenterolong，zhongshan Hospital，Shanghai Medical University，Shanghai 200032 Abstract Aim To assess the cost-effectiveness of diagnosis by laparascopy of difficult and complicated abdominal diseases . Methods The diagnostic methods of　the 31 cases of difficult and complicated abdominal diseases were divided into four groups: a basic group（namely, repeated ascites tests after puncture and ultrasonography），a enhanced CT group， a laparatory group and a alliance group of the above mentioned three groups． The diagnostic rates, the average costs per one case which was correctly diagnosed in the above four groups, and having compared with the based group , the increased costs in the latter three groups while added one case was diagnosed correctly were calculated respectively.. The costs were calculated according to the standard of Ⅲ A grade hospitals in the province of Yunnan. Sensitivity analysis of the four groups was made, too. Results The diagnostic rates were 2/31, 6/31, 30/31 and 30/31; the average costs were￥3348.90, ￥4511.43