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Cost-effectiveness analysis of diagnostic strategies for suspected pulmonary embolism including helical computed tomography.
Am J Respir Crit Care Med 2003; 167(1):39-44AJ

Abstract

We performed a formal decision analysis to evaluate the cost-effectiveness of various strategies for pulmonary embolism, including helical computed tomography (CT), and determined the most cost-effective schemes for each clinical probability of pulmonary embolism. Other tests included D-dimer (DD), lower limb venous ultrasound (US), ventilation-perfusion (V/Q) scan, and angiography. Outcome measures were 3-month survival and costs per patient managed. Baseline sensitivity of CT was 70%, corresponding to the performance of single-detector CT, and that figure was raised in sensitivity analysis to account for the expected higher sensitivity of newer multidetector CT scanners. All strategies were compared with a reference strategy, namely the V/Q scan in all patients followed when nondiagnostic by an angiogram. For low clinical probability patients, the most cost-effective strategy was DD, US, and V/Q scan, patients with a nondiagnostic V/Q scan being left untreated. Replacing V/Q scan by CT was also cost-effective. For intermediate and high clinical probability patients, a fourth test must be added, either CT or angiography in patients with nondiagnostic V/Q scan, or angiography in patients with a negative helical CT. When using sensitivity figures above 85% (in the multidetector range), DD, US, and CT became the most cost-effective strategy for all clinical probability categories. Helical CT as a single test was not cost-effective. In summary, including helical CT in diagnostic strategies for pulmonary embolism is cost-effective provided that it is combined with DD and US. In contrast, helical CT as a single test is not cost-effective.

Authors+Show Affiliations

Medical Clinic 1, Geneva University Hospital, Geneva, Switzerland. arnaud.perrier@medecine.unige.chNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12502474

Citation

Perrier, Arnaud, et al. "Cost-effectiveness Analysis of Diagnostic Strategies for Suspected Pulmonary Embolism Including Helical Computed Tomography." American Journal of Respiratory and Critical Care Medicine, vol. 167, no. 1, 2003, pp. 39-44.
Perrier A, Nendaz MR, Sarasin FP, et al. Cost-effectiveness analysis of diagnostic strategies for suspected pulmonary embolism including helical computed tomography. Am J Respir Crit Care Med. 2003;167(1):39-44.
Perrier, A., Nendaz, M. R., Sarasin, F. P., Howarth, N., & Bounameaux, H. (2003). Cost-effectiveness analysis of diagnostic strategies for suspected pulmonary embolism including helical computed tomography. American Journal of Respiratory and Critical Care Medicine, 167(1), pp. 39-44.
Perrier A, et al. Cost-effectiveness Analysis of Diagnostic Strategies for Suspected Pulmonary Embolism Including Helical Computed Tomography. Am J Respir Crit Care Med. 2003 Jan 1;167(1):39-44. PubMed PMID: 12502474.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness analysis of diagnostic strategies for suspected pulmonary embolism including helical computed tomography. AU - Perrier,Arnaud, AU - Nendaz,Mathieu R, AU - Sarasin,François P, AU - Howarth,Nigel, AU - Bounameaux,Henri, PY - 2002/12/28/pubmed PY - 2003/2/14/medline PY - 2002/12/28/entrez SP - 39 EP - 44 JF - American journal of respiratory and critical care medicine JO - Am. J. Respir. Crit. Care Med. VL - 167 IS - 1 N2 - We performed a formal decision analysis to evaluate the cost-effectiveness of various strategies for pulmonary embolism, including helical computed tomography (CT), and determined the most cost-effective schemes for each clinical probability of pulmonary embolism. Other tests included D-dimer (DD), lower limb venous ultrasound (US), ventilation-perfusion (V/Q) scan, and angiography. Outcome measures were 3-month survival and costs per patient managed. Baseline sensitivity of CT was 70%, corresponding to the performance of single-detector CT, and that figure was raised in sensitivity analysis to account for the expected higher sensitivity of newer multidetector CT scanners. All strategies were compared with a reference strategy, namely the V/Q scan in all patients followed when nondiagnostic by an angiogram. For low clinical probability patients, the most cost-effective strategy was DD, US, and V/Q scan, patients with a nondiagnostic V/Q scan being left untreated. Replacing V/Q scan by CT was also cost-effective. For intermediate and high clinical probability patients, a fourth test must be added, either CT or angiography in patients with nondiagnostic V/Q scan, or angiography in patients with a negative helical CT. When using sensitivity figures above 85% (in the multidetector range), DD, US, and CT became the most cost-effective strategy for all clinical probability categories. Helical CT as a single test was not cost-effective. In summary, including helical CT in diagnostic strategies for pulmonary embolism is cost-effective provided that it is combined with DD and US. In contrast, helical CT as a single test is not cost-effective. SN - 1073-449X UR - https://www.unboundmedicine.com/medline/citation/12502474/Cost_effectiveness_analysis_of_diagnostic_strategies_for_suspected_pulmonary_embolism_including_helical_computed_tomography_ L2 - http://www.atsjournals.org/doi/full/10.1164/rccm.2106128?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -