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Russell D. Hull, MBBS; William Feldstein, MBA; Paul D. Stein, MD; Graham F. Pineo, MD

Arch Intern Med. 1996;156(1):68-72.

Abstract
Background
In recent years, improvements in the methods of clinical trials and the use of objective tests to detect venous thrombosis have enhanced the clinician's ability to diagnose pulmonary embolism.

Objective
To perform a cost-effectiveness analysis of the commonly recommended strategies for pulmonary embolism diagnosis and management.

Methods
Two criteria of effectiveness were used: correct identification of pulmonary embolism and correct identification of patients in whom treatment was unnecessary. The cost of each diagnostic alternative was defined as the direct cost of administering the diagnostic test plus the treatment cost associated with a positive test result. Data derived from a decision analysis published separately on 662 patients were used for this study.

Results
A strategy based on the use of ventilation-perfusion lung scans, serial impedance plethysmography, and pulmonary angiography was the most cost-effective. It remained so under all possible variations within the sensitivity analysis.

Conclusions
The strategy that requires pulmonary angiography in the fewest patients is a combination of ventilation-perfusion lung scans and serial impedance plethysmography. This strategy also proved to be the most cost-effective.

(Arch Intern Med. 1996;156:68-72)

Author Affiliations
From the Department of Medicine (Drs Hull and Pineo) and Clinical Trials Unit (Mr Feldstein), University of Calgary (Alberta), and Henry Ford Heart and Vascular Institute, Detroit, Mich (Dr Stein).

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