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目的胶囊内镜(capsule endoscopy,CE)已被多国广泛用于诊断小肠疾病,为将CE纳入我国医保目录、加大向基层医院示范推广力度,政府急需高质量证据帮助决策。本研究旨在全面了解全球胶囊内镜诊断小肠疾病的有效性、安全性、适用性和经济性,为政府卫生政策制定者提供当前可得的最佳决策证据。方法计算机检索h e Cochrane Library(2013年第8期)、PubMed、EMbase、INAHTA、VIP、CBM、CNKI和WanFang Data。按照纳入与排除标准筛选文献、提取资料和评价质量,然后综合分析得出结论。结果最终共纳入32个研究,其中卫生技术评估(HTA)、系统评价(SR)/Meta分析、随机对照试验(RCT)、指南和经济学研究分别为4、11、2、5和10个。其结果均显示,CE检出率高于其他多项相关传统技术,主要不良事件为胶囊滞留(0.7%~3.0%),与指南推荐一致。经济学分析结果显示,与其他技术相比,CE作为首选可明显降低潜在成本,且门诊患者潜在成本降低最显著。结论①CE诊断小肠疾病优势明显且较安全,比同类技术更能降低潜在成本。但使用存在一定局限性,仍需高质量证据证实。②建议政府在批准医院引进CE时,需综合考虑当地疾病负担、临床需求、支付能力和人员配套等因素。同时须强调进一步规范化培训操作医师,减少因医务人员个人技术原因造成的经济损失。
Objective Capsule endoscopy (CE) has been widely used in many countries to diagnose small bowel diseases. In order to incorporate CE into our medical insurance catalog and increase the demonstration and promotion to primary hospitals, the government urgently needs high-quality evidence to help decision-making. The purpose of this study is to provide a comprehensive understanding of the effectiveness, safety, suitability and economy of the global capsule endoscopy in the diagnosis of small bowel disease and to provide government health policymakers with the best available evidence of decision-making right now. Methods We searched the Internet Library (2013 issue 8), PubMed, EMbase, INAHTA, VIP, CBM, CNKI and WanFang Data. According to inclusion and exclusion criteria screening documents, data extraction and quality evaluation, and then concluded that a comprehensive analysis. Results A total of 32 studies were included. Among them, HTA, SR / Meta analysis, RCT, guideline and economics were 4, 11, 2, 5 and 10 respectively. The results showed that the detection rate of CE was higher than that of many other related traditional techniques. The main adverse event was capsule retention (0.7% -3.0%), which was consistent with the recommended guidelines. Economic analysis shows that, compared with other technologies, CE as the first choice can significantly reduce the potential costs, and outpatient potential cost reduction the most significant. Conclusions ① The diagnosis of small bowel disease by CE is more obvious and safer, which can reduce the potential cost more than other similar technologies. However, the use of certain limitations, still need high-quality evidence confirmed. ② It is suggested that when approving the introduction of CE into a hospital, the government should take into consideration factors such as local disease burden, clinical needs, ability to pay and staffing. At the same time, we must emphasize further standardizing the training of physicians and reducing the economic losses caused by the personal technical causes of medical personnel.