Cost-effectiveness Analysis of Various Strategies in the Diagnostic Management of Pulmonary Embolism

doi:10.1001/archinte.1993.00410080017003

You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.

Vol. 153 No. 8, 26 APR 1993

Online Only
	•	Online First Table of Contents

Original Investigations

•	Online Features

This Article
•	References
•	Full text PDF
•	Reply to article
•	Send to a friend
•	Save in My Folder
•	Save to citation manager
•	Permissions

Citing Articles
•	Citation map
•	Citing articles on HighWire
•	Citing articles on Web of Science (95)
•	Contact me when this article is cited

Related Content
•	Similar articles in this journal

Social Bookmarking
	What's this?

Cost-effectiveness Analysis of Various Strategies in the Diagnostic Management of Pulmonary Embolism

Matthijs Oudkerk, MD, PhD; Edwin J. R. van Beek, MD; Wim L. J. van Putten, MSc; Harry R. Büller, MD, PhD

Arch Intern Med. 1993;153(8):947-954.

Abstract

Background
Since the clinical diagnosis of pulmonary embolism is unreliable,various objective diagnostic methods (or combinations thereof)are advocated. Pulmonary angiography is the accepted referencemethod but is considered less suitable for initial screeningdue to its invasive nature. Therefore, at least nine differentdiagnostic management strategies employing invasive and noninvasivediagnostic tests are used in clinical practice. We assessedthe cost-effectiveness of these strategies to help identifythe optimal approach.

Methods
Based on assumptions derived from published data, we calculatedmortality, morbidity, adequacy for the indication of anticoagulanttherapy, and associated diagnostic and therapeutic costs usinga decision analytic model. Additionally, a cost-effectivenessanalysis was performed using incremental costs per additionallife saved.

Results
The analysis identified three separate categories of diagnosticmanagement strategies: (1) Treatment of all patients (or ofthose with an abnormal perfusion scan) results in the lowestmortality and morbidity rates but the highest costs due to inappropriatetreatment of 55% to 70% of patients. (2) Pulmonary angiographystrategies with or without prior perfusion-ventilation lungscintigraphy and ultrasonography of the legs have comparablelow mortality and morbidity rates, costs savings of approximately40%, and inappropriate treatment in fewer than 5% of patients.(3) Use of perfusion-ventilation scintigraphy with or withoutultrasonography results in unacceptably high mortality rates.

Conclusions
At present, the optimal diagnostic management strategy shouldinclude pulmonary angiography. Use of perfusion-ventilationlung scintigraphy and ultrasonography results in a 40% to 50%reduction in the number of patients requiring pulmonary angiographyand is cost-effective.

(Arch Intern Med. 1993;153:947-954)

Author Affiliations

From the Departments of Radiodiagnostics (Dr Oudkerk) and Biostatistics (Dr van Putten), Dr Daniel den Hoed Cancer Center, Rotterdam, and the Centre for Haemostasis, Thrombosis, Atherosclerosis and Inflammation Research, Academic Medical Centre, University of Amsterdam (Drs van Beek and Büller), the Netherlands.

Add to CiteULike CiteULike Add to Connotea Connotea Add to Delicious Delicious Add to Digg Digg Facebook Add to Reddit Reddit Add to Technorati Technorati Twitter What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Imaging of pulmonary embolism: an overview
van Beek et al.
Pulmonary Vascular Pathology: a Clinical Update 2010;1:110-123.
ABSTRACT

Evidence-based diagnostic algorithms for pulmonary embolism: why are they necessary?
Perrier
Pulmonary Vascular Pathology: a Clinical Update 2010;1:165-176.
ABSTRACT

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

Cost-effectiveness of Noninvasive Diagnostic Aids in Suspected Pulmonary Embolism
Perrier et al.
Arch Intern Med 1997;157:2309-2316.
ABSTRACT

Antithrombotic Strategy After Total Hip Replacement: A Cost-effectiveness Analysis Comparing Prolonged Oral Anticoagulants With Screening for Deep Vein Thrombosis
Sarasin and Bounameaux
Arch Intern Med 1996;156:1661-1668.
ABSTRACT

Blunt Thoracic Aortic Trauma: A Cost-Utility Approach for Injury Detection
Brasel and Weigelt
Arch Surg 1996;131:619-626.
ABSTRACT

Diagnosis of Pulmonary Embolism by a Decision Analysis-Based Strategy Including Clinical Probability, D-Dimer Levels, and Ultrasonography: A Management Study
Perrier et al.
Arch Intern Med 1996;156:531-536.
ABSTRACT

Diagnosis and Management of Pulmonary Embolism
Greenfield and Proctor
Ann. Thorac. Surg. 1996;61:1037-1037.
FULL TEXT

| | |