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目的 对头颅CT在癫痫诊断中的作用进行成本 效果研究 ,探讨其有效性和合理性。方法 1995年至 2 0 0 0年对我院门诊新诊断的癫痫患者进行前瞻性头颅CT研究 ,寻找病因 ,并计算头颅CT每发现 1例有意义病变的费用 ,进行成本 效果分析。结果 全面性癫痫发作 5 72例 ,部分性癫痫发作 174例患者参加了研究。CT扫描总的异常率为 32 % ,其中非特异性异常率为 2 2 % ,特异性异常率仅为 10 %。在神经系统或脑电图检查无局灶异常的全面性发作患者中 ,特异性异常率为 0 % ,头颅CT发现有严重脑部病变的成本将不低于 6 4 2 14元 ;而在有局灶异常的部分性发作患者中 ,特异性异常率为 5 0 % ,发现有严重脑部病变的成本仅为 80 0元 (头颅CT扫描的费用约 4 0 0元 /次 )。结论 在目前卫生保健资源紧缺的情况下 ,医生对患者进行实验室和影像学检查时 ,既要考虑诊断的需要 ,又应着眼于成本 效果分析。
Objective To study the cost-effectiveness of cranial CT in the diagnosis of epilepsy and explore its effectiveness and rationality. Methods From 1995 to 2000, prospective CT scans of newly diagnosed epilepsy in our hospital were performed to find out the cause of the disease and to calculate the cost-effectiveness analysis for each case of one significant lesion identified by skull CT. Results A total of 5 72 cases of epileptic seizures, partial seizures in 174 patients participated in the study. The total abnormality rate of CT scan was 32%, of which the nonspecific abnormality rate was 22% and the specific abnormality rate was only 10%. The specific abnormality rate is 0% in patients with a comprehensive seizure without a focal abnormality in the nervous system or electroencephalogram examination. The cost of a craniocerebral CT scan for finding a serious brain lesion will not be less than $ 64,214. In patients with focal abnormalities, the specific abnormality rate was 50%. The cost of finding a severe brain lesion was only 80% (the cost of head CT scan was about 400 yuan / time). Conclusions In the current shortage of health care resources, doctors should not only consider the need of diagnosis but also pay attention to the cost-effectiveness analysis when conducting laboratory and radiological examination of patients.