Ali Hosseini, Samira

Simorgh Research Repository

    دا஺ه ﻋ࢖ﻮم ﭘﺰﺷਔﯽ ໊ඟﻣﺎن داﻧﺸﻜﺪه ﻣﺪﻳﺮﻳﺖ و اﻃﻼع رﺳﺎﻧﻲ ﭘﺰﺷﻜﻲ  ي ارزﻳﺎﺑﻲ ﻓﻨﺎوري ﺳﻼﻣﺖ ﭘﺎﻳﺎن ﻧﺎﻣﻪ ﻣﻘﻄﻊ ﻛﺎرﺷﻨﺎﺳﻲ ارﺷﺪ رﺷﺘﻪ  ﻋﻨﻮان:ر ﻣﻘﺎﻳﺴﻪ ﺑﺎ دﻛﻮﻟﻮن  ﻓﻨﺎوري ﻧﺴﻞ دوم ﻛﭙﺴﻮل آﻧﺪوﺳﻜﻮﭘﻲ ارزﻳﺎﺑﻲ  ﻧﻮﺳﻜﻮﭘﻲ در ﺗﺸﺨﻴﺺ ﺳﺮﻃﺎن روده ﺑﺰرگﻛﻮﻟﻮ  ﺗﻮﺳﻂ: ﺳﻤﻴﺮا ﻋﻠﻲ ﺣﺴﻴﻨﻲ  راﻫﻨﻤﺎ:  اناﺳﺘﺎد دﻛﺘﺮ اﺳﻤﺎ ﺻﺎﺑﺮﻣﺎﻫﺎﻧﻲ دﻛﺘﺮ آﻳﺪﻳﻦ آرﻳﻦ ﺧﺼﺎل   7931 -8931ﺳﺎل ﺗﺤﺼﻴﻠﻲ:     ﭼﻜﻴﺪهﺑﻪ ﻋﻨﻮان ﺳﻮﻣﻴﻦ ﻧﻮع ﺷﺎﻳﻊ ﺳﺮﻃﺎن و ﻋﻠﺖ ﭼﻬﺎرم ﻣﺮگ در ﺳﺮاﺳﺮ ﺟﻬﺎن ﻣﺤﺴﻮب ﻣﻲ  روده ﺑﺰرگ: ﺳﺮﻃﺎن ﻣﻘﺪﻣﻪ و اﻫﺪافﻣﻌﺮﻓﻲ ﺷﺪه  روده ﺑﺰرگﺟﺪﻳﺪ ﺑﺮاي ﺗﺸﺨﻴﺺ ﺳﺮﻃﺎن ﻓﻨﺎوري ﺑﻪ ﻋﻨﻮان ﻳﻚ  روده ﺑﺰرگﺷﻮد. ﻧﺴﻞ دوم ﻛﭙﺴﻮل آﻧﺪوﺳﻜﻮﭘﻲ ﻓﻨﺎوري ﺟﻨﺒﻪ ﻫﺎي اﺧﻼﻗﻲ، اﺟﺘﻤﺎﻋﻲ و ﺳﺎزﻣﺎﻧﻲ ﺑﺮرﺳﻲ اﺳﺖ. ﻫﺪف اﻳﻦ ﻣﻄﺎﻟﻌﻪ ارزﻳﺎﺑﻲ اﺛﺮﺑﺨﺸﻲ، اﻳﻤﻨﻲ، ﻫﺰﻳﻨﻪ اﺛﺮﺑﺨﺸﻲ و ﻧﺴﻞ دوم ﻛﭙﺴﻮل آﻧﺪوﺳﻜﻮﭘﻲ روده ﺑﺰرگ در ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﻛﻮﻟﻮﻧﻮﺳﻜﻮﭘﻲ ﺑﺮاي ﺗﺸﺨﻴﺺ ﺳﺮﻃﺎن روده ﺑﺰرگ و اﺧﺘﻼﻻت راﻳﺞ در   .آن ﺑﻮددر ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﻛﻮﻟﻮﻧﻮﺳﻜﻮﭘﻲ ﻳﻚ  روده ﺑﺰرگ: ﺑﻪ ﻣﻨﻈﻮر ﻣﻘﺎﻳﺴﻪ اﺛﺮﺑﺨﺸﻲ و اﻳﻤﻨﻲ ﻛﭙﺴﻮل آﻧﺪوﺳﻜﻮﭘﻲ روش ﭘﮋوﻫﺶﻫﺎي ﻧﺴﻞ دوم ﻛﭙﺴﻮل آﻧﺪوﺳﻜﻮﭘﻲ  ﺑﺎ ﻛﻠﻴﺪ واژه ﻧﻈﺎم ﻣﻨﺪ ﻣﺘﻮندﺳﺘﻲ در ﻣﺠﻼت ﻣﻌﺘﺒﺮ و ﻫﻤﭽﻨﻴﻦ ﻳﻚ ﺟﺴﺘﺠﻮي  ﻮيﺟﺴﺘﺠﺗﺎ  6002از ﺳﺎل  tceriD esneicSو  yrarbiL enarhcoC، supocS، deMbuPدر ﭘﺎﻳﮕﺎه ﻫﺎي  ﻛﻮﻟﻮن و ﻛﻮﻟﻮﻧﻮﺳﻜﻮﭘﻲﺑﺮاي ﻧﻤﺎﻳﺶ ﻳﺎﻓﺘﻪ ﻫﺎ اﺳﺘﻔﺎده ﺷﺪ.  دو -ﻚ ﻟﻴﺴﺖ ﻛﻮآداست از ﭼاﻧﺠﺎم ﮔﺮﻓﺖ. ﺑﺮاي ارزﻳﺎﺑﻲ ﻛﻴﻔﻴﺖ ﻣﻄﺎﻟﻌﺎ 8102ﭘﺎﻳﺎن ﻓﻮرﻳﻪ ﺟﻨﺒﻪ اﺧﻼﻗﻲ، ﺳﺎزﻣﺎﻧﻲ و اﺟﺘﻤﺎﻋﻲ ﻓﻨﺎوري ﺑﺎ اﺳﺘﻔﺎده از ﺳﻨﺪ ﭘﻴﺸﻨﻬﺎدي ارزﻳﺎﺑﻲ ﻓﻨﺎوري از ﻧﻤﻮدار اﻧﺒﺎﺷﺖ اﺳﺘﻔﺎده ﺷﺪه اﺳﺖ.  ﻧﻈﺎم ﺳﻼﻣﺖﻫﺰﻳﻨﻪ ﻫﺎ از دﻳﺪﮔﺎه  ﻣﻮرد ﺑﺮرﺳﻲ ﻗﺮار ﮔﺮﻓﺖ. ﻣﺖ در اﻳﺮان و ﺑﻪ ﺻﻮرت ﻣﺼﺎﺣﺒﻪ از ﻣﺘﺨﺼﺺ داﺧﻠﻲ و ﭘﺮﺳﺘﺎرﺳﻼﺗﻬﺮان ﺑﺎ اﺳﺘﻔﺎده ارزﻳﺎﺑﻲ ﮔﺮدﻳﺪ و اﻃﻼﻋﺎت ﻣﻮرد ﻧﻴﺎز در ﺧﺼﻮص ﻫﺰﻳﻨﻪ ﻫﺎي ﻫﺮ دو ﻓﻨﺎوري ﺑﺎ ﻣﺮاﺟﻌﻪ ﺑﻪ ﺑﻴﻤﺎرﺳﺘﺎن ﻓﻴﺮوزﮔﺮ ﻧﺘﺎﻳﺞ ﺑﺎ درﺧﺖ  و ﺑﺎ ﻛﻤﻚ ﻧﺮم اﻓﺰار ﺗﺮي اﻳﺞ ﺗﺤﻠﻴﻞ ﻫﺰﻳﻨﻪ اﺛﺮﺑﺨﺸﻲ ﺻﻮرت ﮔﺮﻓﺖ. آوري ﺷﺪ ﺟﻤﻊاز ﭼﻚ ﻟﻴﺴﺖ ﻫﺰﻳﻨﻪ ﻳﺎﺑﻲ ، ﻫﺰﻳﻨﻪ در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻣﻨﺪ ﻣﺘﻮن ﻣﺮور ﻧﻈﺎمدر  ﺑﺪﺳﺖ آﻣﺪه ارزﻳﺎﺑﻲ اﺛﺮﺑﺨﺸﻲ ﺗﻮﺟﻪ ﺑﻪ ﻧﺘﺎﻳﺞﺑﺎ ﻴﺮي ﻧﺸﺎن داده ﺷﺪ و ﺗﺼﻤﻴﻢ ﮔ  اﺛﺮﺑﺨﺸﻲ اﻓﺰاﻳﺸﻲ دو ﻓﻨﺎوري ﻣﻮرد ﻣﺤﺎﺳﺒﻪ ﻗﺮار ﮔﺮﻓﺘﻪ اﺳﺖ.در ﺑﻪ ﺻﻮرت ﺟﺴﺘﺠﻮي دﺳﺘﻲ  ﻫﻢ رﻛﻮرد 8رﻛﻮرد و  274ﺣﺪود  از ﺟﺴﺘﺠﻮي ﻧﻈﺎم ﻣﻨﺪ ﭘﺎﻳﮕﺎه ﻫﺎي اﻃﻼﻋﺎﺗﻲ :ﻳﺎﻓﺘﻪ ﻫﺎ 6ﻣﻘﺎﻟﻪ ﺣﺴﺎﺳﻴﺖ و وﻳﮋﮔﻲ ﺗﺸﺨﻴﺺ ﭘﻮﻟﻴﭗ  5ﻣﻘﺎﻟﻪ ﺑﻪ ﻣﺮﺣﻠﻪ ﻧﻬﺎﻳﻲ رﺳﻴﺪﻧﺪ ﻛﻪ  8ﻣﺠﻼت ﺑﻪ دﺳﺖ آﻣﺪ. از اﻳﻦ ﺗﻌﺪاد ﻣﻄﺎﻟﻌﻪ ﻣﻘﺎﻟﻪ ﺑﻪ ﮔﺰارش ﺗﺸﺨﻴﺺ ﭘﻮﻟﻴﭗ در ﻫﺮ ﺳﺎﻳﺰي ﭘﺮداﺧﺘﻪ ﺑﻮدﻧﺪ. ﻣﻘﺪار ﺣﺴﺎﺳﻴﺖ  2ﻣﻴﻠﻴﻤﺘﺮ و ﺑﺎﻻﺗﺮ را ﮔﺰارش ﻛﺮده ﺑﻮدﻧﺪ.  01و % و ﺑﺮاي 88% و 48ﻣﻴﻠﻴﻤﺘﺮ ﺑﻪ ﺗﺮﺗﻴﺐ ﺑﺮاﺑﺮ ﺑﺎ  6ﻟﻴﺰ ﺑﺮاي ﺗﺸﺨﻴﺺ ﭘﻮﻟﻴﭗ در ﺳﺎﻳﺰ و وﻳﮋﮔﻲ ﺑﺪﺳﺖ آﻣﺪه در ﻣﺮﺣﻠﻪ ﻣﺘﺎآﻧﺎظ ارزﻳﺎﺑﻲ اﻳﻤﻨﻲ ﻛﭙﺴﻮل %  اﺳﺖ. از ﻟﺤﺎ69% و 48ﺑﺮاﺑﺮ ﺑﺎ  ﺑﻪ ﺗﺮﺗﻴﺐ ﻣﻴﻠﻴﻤﺘﺮ ﺣﺴﺎﺳﻴﺖ و وﻳﮋﮔﻲ 01ﺗﺸﺨﻴﺺ ﭘﻮﻟﻴﭗ  ز وﺷﺪه ﻛﭙﺴﻮل ﺑﺮآورد . ﻫﺰﻳﻨﻪ ﺗﻬﺪﻳﺪ ﻧﻜﺮده ﺑﻮدﺎران را ي ﺧﺎﺻﻲ ﺑﻴﻤ ﻛﻪ ﻣﺨﺎﻃﺮهآﻧﺪوﺳﻜﻮﭘﻲ، ﻧﺘﺎﻳﺞ ﻣﺮور ﻧﻈﺎم ﻣﻨﺪ ﻣﺘﻮن ﻧﺸﺎن داد رﻳﺎل  920,534,11در ﻣﻘﺎﺑﻞ آن، ﻫﺰﻳﻨﻪ ﻛﻮﻟﻮﻧﻮﺳﻜﻮﭘﻲ ﺣﺪود  رﻳﺎل ﺑﺪﺳﺖ آﻣﺪ ﻛﻪ 920,455,321ﺣﺪود  روده ﺑﺰرگآﻧﺪوﺳﻜﻮﭘﻲ درﺳﺖ ﺗﺸﺨﻴﺺ داده ﺷﺪه  ﻣﻮردﻫﺰﻳﻨﻪ ﺑﻪ ازاي ﻫﺮ  793,539,505,3ﻣﻘﺪار ﻧﺴﺒﺖ ﻫﺰﻳﻨﻪ اﺛﺮﺑﺨﺸﻲ اﻓﺰاﻳﺸﻲ ﺣﺪود ﺑﺮآورد ﺷﺪ.  ﺗﻤﺎﻣﻲ ﻣﻼﺣﻈﺎت اﺧﻼﻗﻲ ﻣﺪﻧﻈﺮ ﻗﺮار ﮔﺮﻓﺖﺑﻌﺎد اﺧﻼﻗﻲ و ﺳﺎزﻣﺎﻧﻲ و اﺟﺘﻤﺎﻋﻲ، در ﻣﺼﺎﺣﺒﻪ ﺑﺎ ﺻﺎﺣﺒﻨﻈﺮان از ﻟﺤﺎظ اﻣﻲ ﺑﺎﺷﺪ.   ﮕﺮدﻳﺪ.ﻣﺸﺨﺼﻲ ﻣﻄﺮح ﻧ و اﺟﺘﻤﺎﻋﻲ ﺳﺎزﻣﺎﻧﻲ اﺧﻼﻗﻲ و ﻣﻮاﻧﻊ وﻫﺎ و ﺳﺮﻃﺎن  ﺑﻲ در ﺗﺸﺨﻴﺺ ﭘﻮﻟﻴﭗ: اﻳﻦ ﺑﺮرﺳﻲ ﻧﺸﺎن داد ﻛﻪ ﻧﺴﻞ دوم ﻛﭙﺴﻮل آﻧﺪوﺳﻜﻮﭘﻲ داراي دﻗﺖ ﺧﻮﻧﺘﻴﺠﻪ ﮔﻴﺮيي ي ﺑﺴﻴﺎر ﺑﺎﻻﺗﺮ ﻛﻮﻟﻮﻧﻮﺳﻜﻮﭘﻲ ﻫﺰﻳﻨﻪﺑﺎ  وﻟﻲ در ﻣﻘﺎﻳﺴﻪ داﺷﺖاﻳﻤﻨﻲ ﺑﺎﻻﻳﻲ  ﻫﻤﭽﻨﻴﻦ و ﺑﻮددر ﻣﻴﺎن ﺑﻴﻤﺎران  روده ﺑﺰرگ، ﺑﻮدرﻳﺎل  ﻣﻴﻠﻴﻮن 496ﺑﺮاﺑﺮ ﺑﺎ  6931ﺗﻮﺟﻪ ﺑﻪ ﺣﺪ آﺳﺘﺎﻧﻪ ﺳﻪ ﺑﺮاﺑﺮ ﺳﺮاﻧﻪ ﺗﻮﻟﻴﺪ ﻧﺎﺧﺎﻟﺺ ﻣﻠﻲ ﻛﺸﻮر اﻳﺮان ﻛﻪ در ﺳﺎل و ﺑﺎ  داﺷﺖاﻳﻤﻨﻲ و  ﻫﺎ ﻫﻤﭽﻮن وﺟﻮد در ﺻﻮرت در ﻧﻈﺮ ﮔﺮﻓﺘﻦ ﺳﺎﻳﺮ ﺟﻨﺒﻪاﻳﻦ . ﺑﺎ ﺷﻨﺎﺧﺘﻪ ﺷﺪﺎوري ﻏﺎﻟﺐ در اﻳﻦ ﺗﺤﻠﻴﻞ ﻛﻮﻟﻮﻧﻮﺳﻜﻮﭘﻲ ﻓﻨﺳﺎﻳﺮ اﺑﻌﺎد ﺟﺎﻳﮕﺎه ﻗﺎﺑﻞ در  روده ﺑﺰرگاﻧﺘﺨﺎب ﺑﻴﻦ ﮔﺰﻳﻨﻪ ﻫﺎ ﺗﻐﻴﻴﺮ ﻛﻨﺪ. ﭼﺮا ﻛﻪ ﻛﭙﺴﻮل آﻧﺪوﺳﻜﻮﭘﻲ  ﻣﻤﻜﻦ اﺳﺖ ﺑﻴﺖﻣﻄﻠﻮﻗﺎﺑﻞ ﺗﻮﺻﻴﻪ ﺑﺮاي اﺳﺘﻔﺎده ﺑﺎﺷﺪ آن در داﺧﻞ ﻛﺸﻮر،  ﻧﻤﻮﻧﻪ ﻣﺸﺎﺑﻪ ي ﺗﻮﻟﻴﺪ ﺑﻮﺳﻴﻠﻪي آن  ﻗﺒﻮﻟﻲ دارد و ﭼﻪ ﺑﺴﺎ ﺑﺎ ﻛﺎﻫﺶ ﻫﺰﻳﻨﻪ  وﻟﻲ ﺑﺎ ﺷﺮاﻳﻂ ﻛﻨﻮﻧﻲ و ﺑﺎﻻ ﺑﻮدن ﻫﺰﻳﻨﻪ آن اﻳﻦ روش ﻫﺰﻳﻨﻪ اﺛﺮﺑﺨﺶ ﻧﻤﻲ ﺑﺎﺷﺪ.  : واژهﻛﻠﻴﺪ  ، ارزﻳﺎﺑﻲ ﻓﻨﺎوري ﺳﻼﻣﺖروده ﺑﺰرگ، ﻛﻮﻟﻮﻧﻮﺳﻜﻮﭘﻲ، ﻫﺰﻳﻨﻪ اﺛﺮﺑﺨﺸﻲ، اﺛﺮﺑﺨﺸﻲ، ﺳﺮﻃﺎن روده ﺑﺰرگﻛﭙﺴﻮل آﻧﺪوﺳﻜﻮﭘﻲ          Abstract Introduction & Objectives: Colon cancer is considered as the third most common type of cancer and the fourth cause of death worldwide. The second-generation colon capsule endoscopy has been introduced as a new technology for the diagnosis of colon cancer. The purpose of this study was to evaluate the second-generation colon capsule endoscopy in comparison with the colonoscopy for the diagnosis of colon cancer and common disorders, which includes examination of effectiveness, safety, cost-effectiveness and ethical, social and organizational aspects of the colon capsule endoscopy. Methods: In order to compare the effectiveness and safety of colon capsule endoscopy compared to colonoscopy, a manual search in valid journals, as well as a systematic search was carried out through searching the databases of PubMed, Scopus, Cochrane Library, and Science Direct databases, from 2006 until the end of February 2018. To assess the quality of the studies, the QUADAS-2 checklist was used. The Forest Plot has been used to display the findings. The ethical, organizational, and social aspects of the technologies were examined based on a proposed health technology assessment document in Iran and via interviews by several internal medicine consultants and nurses. Costs were evaluated from the health system’s perspective, and information about the costs of the technologies was collected by referring to Firoozgar Hospital in Tehran and was used a cost-check list. The TreeAge Pro software was used for data modeling and the results were shown with the decision tree. Regarding the results of the systematic review of this study, the incremental cost effectiveness of the two technologies was compared. Results: 472 records were identified through searching the electronic databases and 8 more from hand searching. Out of these, 8 papers were selected, with 5 papers reporting the sensitivity and specificity of polyps 6, 10 mm and above. Two papers reported results with no specific size. The pulled sensitivity and specificity based on the meta-analysis for the detection of polyps in a size of 6 mm were 84% and 88%, respectively, and for 10 mm polyps, the sensitivity and specificity were 84% and 96%, respectively. In terms of safety, the capsule endoscopy colon did not pose a particular risk on patients. The estimated cost of the capsule endoscopy colon was about 123,554,843 Rials while the cost of colonoscopy was 11,435,029 Rials. The value of the cost-effectiveness ratio is estimated as 3,505,935,397 per item. In terms of ethical, organizational and social dimensions, the interviewees had a favorable opinion about using capsules endoscopy colon. Conclusion: This study showed that the second generation colon capsule endoscopy has a good accuracy in detecting polyps and colon cancer among patients with moderate to high risk and that it has high safety. Considering the threshold of three times of Iran’s GDP per capita, which equals to 694 milion Rials in 2017, it seems that the colonoscopy is cost effective. However, choosing between options may change if other aspects are taken into account, such as safety and utility, and ethical and organizational aspects. Because the colon endoscopy capsule has a decent position in other aspects than colonoscopy, it may be recommended for use with its cost reduction  by producing a similar specimen inside the country, but with current conditions and high cost, this method is not cost effective. Keywords: Colon capsule endoscopy, Colonoscopy, Cost effectiveness, Effectiveness, Colon cancer, Health Technology Assessment      Kerman University of Medical Sciences  Faculty of Management and Medical Information In Partial Fulfillment of the Requirements for the Degree MSc Health Technology Assessment  Title: Technology Assessment of Second-generation Colon Capsule Endoscopy compared with colonoscopy in detection of colon cancer By: Samira Alihosseini Supervisors: Dr. Asma Sabermahani Dr. Aidin Aryankhesal Year: 2018  - 2019    

ارزیابی فناوری نسل دوم کپسول آندوسکوپی کولون در مقایسه با کولونوسکوپی در تشخیص سرطان روده بزرگ

http://eprints.kmu.ac.ir/30188/1/6962.pdf

ارزیابی فناوری نسل دوم کپسول آندوسکوپی کولون در مقایسه با کولونوسکوپی در تشخیص سرطان روده بزرگ

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