Cost-effectiveness analysis of various strategies in the diagnostic management of pulmonary embolism
M. Oudkerk, E. J. van Beek, W. L. van Putten and H. R. Buller
Department of Radiodiagnostics, Dr Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.
BACKGROUND: Since the clinical diagnosis of pulmonary embolism is
unreliable, various objective diagnostic methods (or combinations thereof)
are advocated. Pulmonary angiography is the accepted reference method but
is considered less suitable for initial screening due to its invasive
nature. Therefore, at least nine different diagnostic management strategies
employing invasive and noninvasive diagnostic tests are used in clinical
practice. We assessed the cost-effectiveness of these strategies to help
identify the optimal approach. METHODS: Based on assumptions derived from
published data, we calculated mortality, morbidity, adequacy for the
indication of anticoagulant therapy, and associated diagnostic and
therapeutic costs using a decision analytic model. Additionally, a
cost-effectiveness analysis was performed using incremental costs per
additional life saved. RESULTS: The analysis identified three separate
categories of diagnostic management strategies: (1) Treatment of all
patients (or of those with an abnormal perfusion scan) results in the
lowest mortality and morbidity rates but the highest costs due to
inappropriate treatment of 55% to 70% of patients. (2) Pulmonary
angiography strategies with or without prior perfusion-ventilation lung
scintigraphy and ultrasonography of the legs have comparable low mortality
and morbidity rates, costs savings of approximately 40%, and inappropriate
treatment in fewer than 5% of patients. (3) Use of perfusion-ventilation
scintigraphy with or without ultrasonography results in unacceptably high
mortality rates. CONCLUSIONS: At present, the optimal diagnostic management
strategy should include pulmonary angiography. Use of perfusion-ventilation
lung scintigraphy and ultrasonography results in a 40% to 50% reduction in
the number of patients requiring pulmonary angiography and is
cost-effective.
Real-Time Chest Ultrasonography: A Comprehensive Review for the Pulmonologist
Beckh et al.
Chest 2002;122:1759-1773.
ABSTRACT
| FULL TEXT
Strategies Incorporating Spiral CT for the Diagnosis of Acute Pulmonary Embolism : A Cost-effectiveness Analysis
Paterson and Schwartzman
Chest 2001;119:1791-1800.
ABSTRACT
| FULL TEXT
Guidelines on diagnosis and management of acute pulmonary embolism
Eur Heart J 2000;21:1301-1336.
Active implementation of a consensus strategy improves diagnosis and management in suspected pulmonary embolism
BERGHOUT et al.
QJM 2000;93:335-340.
ABSTRACT
| FULL TEXT
Clinically Suspected Pulmonary Embolism: Use of Bilateral Lower Extremity US as the Initial Examination—A Prospective Study
Sheiman and McArdle
Radiology 1999;212:75-78.
ABSTRACT
| FULL TEXT
Deep Venous Thrombosis: Complete Lower Extremity Venous US Evaluation in Patients without Known Risk Factors—Outcome Study
Cornuz et al.
Radiology 1999;211:637-641.
ABSTRACT
| FULL TEXT
Evaluation of a New, Rapid, and Quantitative D-Dimer Test in Patients with Suspected Pulmonary Embolism
OGER et al.
Am. J. Respir. Crit. Care Med. 1998;158:65-70.
ABSTRACT
| FULL TEXT
Diagnosis and Management of Pulmonary Embolism
Greenfield and Proctor
Ann. Thorac. Surg. 1996;61:1037-1037.
FULL TEXT