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A Cost-effectiveness Analysis of Diagnostic Algorithms of Deep Vein Thrombosis at the Emergency Department.

Norlin, Jenny M; Elf, Johan LU ; Svensson, Peter LU and Steen Carlsson, Katarina LU (2010) In Thrombosis Research Jul 1. p.195-199
Abstract
INTRODUCTION: Suspected cases of deep vein thrombosis are common at emergency departments and they often require extensive and costly diagnostic testing. The objective of this study was to evaluate whether a diagnostic algorithm based upon pre-test probability and D-dimer in diagnosing deep vein thrombosis may be cost-effective from a societal perspective in a Swedish setting. MATERIAL AND METHODS: The cost-effectiveness of two alternative diagnostic algorithms were calculated using decision analysis. An algorithm which out ruled deep vein thrombosis among low probability patients with negative D-dimer was compared to a traditional algorithm including compression ultrasonography and/or contrast venography for all patients. For sensitivity... (More)
INTRODUCTION: Suspected cases of deep vein thrombosis are common at emergency departments and they often require extensive and costly diagnostic testing. The objective of this study was to evaluate whether a diagnostic algorithm based upon pre-test probability and D-dimer in diagnosing deep vein thrombosis may be cost-effective from a societal perspective in a Swedish setting. MATERIAL AND METHODS: The cost-effectiveness of two alternative diagnostic algorithms were calculated using decision analysis. An algorithm which out ruled deep vein thrombosis among low probability patients with negative D-dimer was compared to a traditional algorithm including compression ultrasonography and/or contrast venography for all patients. For sensitivity analysis, a third reversed algorithm, where D-dimer was followed by pre-test probability, was analyzed. Estimates of probabilities were obtained from a prospective management study, including 357 outpatients with clinical suspicion of deep vein thrombosis. Direct costs were estimated using prices from Scania, Sweden. Indirect costs were estimated using time spent at the local emergency department and gross average wages in Sweden. RESULTS: The total cost of the pre-test probability and D-dimer algorithm was estimated to euro406 per patient and the traditional algorithm was estimated to euro581 per patient. Reversing the order of the score and test resulted in an estimate of euro421 per patient. CONCLUSION: At no significant difference in diagnostic efficacy the algorithm based upon pre-test probability and D-dimer was cost-effective, while the reversed algorithm and diagnostic imaging for all patients were not. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Thrombosis Research
volume
Jul 1
pages
195 - 199
publisher
Elsevier Ltd
external identifiers
  • wos:000281386000007
  • pmid:20580416
  • scopus:77956266493
ISSN
1879-2472
DOI
10.1016/j.thromres.2010.05.013
language
English
LU publication?
yes
id
d3306b9f-ab88-496c-84b7-514d6a727de2 (old id 1625676)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/20580416?dopt=Abstract
date added to LUP
2010-07-01 22:34:25
date last changed
2018-05-29 11:40:36
@article{d3306b9f-ab88-496c-84b7-514d6a727de2,
  abstract     = {INTRODUCTION: Suspected cases of deep vein thrombosis are common at emergency departments and they often require extensive and costly diagnostic testing. The objective of this study was to evaluate whether a diagnostic algorithm based upon pre-test probability and D-dimer in diagnosing deep vein thrombosis may be cost-effective from a societal perspective in a Swedish setting. MATERIAL AND METHODS: The cost-effectiveness of two alternative diagnostic algorithms were calculated using decision analysis. An algorithm which out ruled deep vein thrombosis among low probability patients with negative D-dimer was compared to a traditional algorithm including compression ultrasonography and/or contrast venography for all patients. For sensitivity analysis, a third reversed algorithm, where D-dimer was followed by pre-test probability, was analyzed. Estimates of probabilities were obtained from a prospective management study, including 357 outpatients with clinical suspicion of deep vein thrombosis. Direct costs were estimated using prices from Scania, Sweden. Indirect costs were estimated using time spent at the local emergency department and gross average wages in Sweden. RESULTS: The total cost of the pre-test probability and D-dimer algorithm was estimated to euro406 per patient and the traditional algorithm was estimated to euro581 per patient. Reversing the order of the score and test resulted in an estimate of euro421 per patient. CONCLUSION: At no significant difference in diagnostic efficacy the algorithm based upon pre-test probability and D-dimer was cost-effective, while the reversed algorithm and diagnostic imaging for all patients were not.},
  author       = {Norlin, Jenny M and Elf, Johan and Svensson, Peter and Steen Carlsson, Katarina},
  issn         = {1879-2472},
  language     = {eng},
  pages        = {195--199},
  publisher    = {Elsevier Ltd},
  series       = {Thrombosis Research},
  title        = {A Cost-effectiveness Analysis of Diagnostic Algorithms of Deep Vein Thrombosis at the Emergency Department.},
  url          = {http://dx.doi.org/10.1016/j.thromres.2010.05.013},
  volume       = {Jul 1},
  year         = {2010},
}