乳房攝影立體定位真空輔助切片的臨床效用與成本效益分析：和細針定位開放性手術切片比較

Efficacy and cost-effectiveness of stereotactic vacuum-assisted biopsy for diagnosis and management of nonpalpable breast lesions

蔡蕙怡(Huei-Yi Tsai)

指導教授 ： 邱亨嘉

高雄醫學大學/健康科學院/醫務管理暨醫療資訊學系碩士在職專班/碩士(2019年)

摘要

研究背景與目的
針對只有乳房攝影能定位的乳房病變，開放性手術切片(OSB)是標準診斷方法，立體定位真空輔助切片(SVAB)則是近年來逐漸廣泛使用的新診斷方式。本研究的目的在比較SVAB和OSB的診斷效用和成本效果差異。
研究方法
採回溯性研究設計，在某醫學中心以病歷審查取得2012至2017年臨床資料，比較不同切片組別的病人及病變特質差異，並且比較診斷正確性、再切片率、及併發症發生率。以串聯醫院醫療申報費用檔的方式得到醫療資源使用數據，並以全國性資料估算間接成本，比較SVAB和OSB的成本效果。最後嘗試將病變分類，找出不同類別的病變耗用資源最少的切片診斷方法。
研究結果
SVAB是可靠的診斷工具。以SVAB取代OSB，病患不用住院，切片時間短，併發症也比較輕微，還可以讓良性病變的病患省去不必要的手術。SVAB達到一個正確診斷的直接成本只比OSB少台幣2,670元 (9.9%)，自費項目金額相對健保給付高是主因；間接成本比OSB少台幣17,538元 (95.2%)，因為OSB的病患需要休息的天數比SVAB長許多。本研究當OSB診斷出惡性病變，有52%不用再接受手術，此時以OSB診斷所產生的資源使用比SVAB少。OSB惡性病變手術率維持在48%時，任一病變惡性機率若低於18%，以SVAB診斷所產生的醫療費用和社會資源耗用較OSB低。
結論
BI-RADS category 3 及 4A的病變以SVAB做為第一線診斷工具可節省醫療費用和社會資源；Category 4B-5以SVAB診斷總體醫療費用可能高過OSB，此時結合醫師的臨床評估能夠更準確選擇耗用資源較少的切片方式。

關鍵字

乳房切片 ； 立體定位 ； 真空輔助切片 ； 成本效果

並列摘要

Aim
To compare the diagnostic accuracy, outcomes, and cost-effectiveness of stereotactic 10-G vacuum-assisted biopsy (SVAB) and open surgical biopsy (OSB) for nonpalpable breast lesions detected using mammography.
Material and Methods
A retrospective review was performed. Direct cost was calculated using patient charges and national health insurance payment. Indirect cost was calculated using sick leave days, average salary, and age-adjusted employment rate.
Results
SVAB was a reliable and safe diagnostic tool which could be an alternative to OSB. Comparing with OSB, SVAB decreased the direct cost of diagnosis by $89 (9.9%) and indirect cost by $556.7 (95.2%) per case. SVAB obviated 92.3% benign surgeries. OSB obviated 52% surgical treatments for malignancies, and therefore, had lower total cost (including diagnosis and treatment) than that of SVAB. Cost saving was $795.3 per case. Lower total cost can be attained if SVAB is the diagnostic method for any lesion with likelihood of malignancy lower than 18%. Any lesion with higher likelihood of malignancy, cost saving can be made by OSB when a malignancy has no need of subsequent surgery. BI-RADS category used at the study correlated well with the percentage of malignancy and can thus be used to assess malignant risk before biopsy.
Conclusion
For lesions of BI-RADS category 3 and 4A, SVAB is the more cost-effective diagnostic method. For lesions of category 4B-5, using SVAB may bring about higher medical resource utilization; therefore, a more complete consideration is needed.

並列關鍵字

stereotactic ； vacuum-assisted biopsy ； cost-effectiveness ； breast biopsy

參考文獻

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