TY - JOUR
T1 - Cost-effectiveness of performing reference ultrasonography in patients with deep vein thrombosis
AU - de Jong, Cindy Michelle Maria
AU - van den Hout, Wilbert
AU - van Dijk, Christel E.
AU - Heim, Noor
AU - van Dam, Lisette F.
AU - Dronkers, Charlotte
AU - Gautam, Gargi
AU - Ghanima, Waleed
AU - Gleditsch, Jostein
AU - von Heijne, Anders
AU - Hofstee, Herman
AU - Hovens, Marcel
AU - Huisman, Menno V.
AU - Kolman, Stan
AU - Mairuhu, Albert T. A.
AU - van Mens, Thijs E.
AU - Nijkeuter, Mathilde
AU - van de Ree, Marcel
AU - van Rooden, Jan-Kees
AU - Westerbeek, Robin E.
AU - Westerink, Jan
AU - Westerlund, Eli
AU - Kroft, Lucia
AU - Klok, Frederikus A.
PY - 2023
Y1 - 2023
N2 - Background: The diagnosis of recurrent ipsilateral deep vein thrombosis (DVT) with compression ultrasonography (CUS) may be hindered by residual intravascular obstruction after previous DVT. A reference CUS, an additional ultrasound performed at anticoagulant discontinuation, may improve the diagnostic work-up of suspected recurrent ipsilateral DVT by providing baseline images for future comparison. Objectives: To evaluate the cost-effectiveness of routinely performing reference CUS in DVT patients. Methods: Patient-level data from a prospective management study (Theia study; NCT02262052) and claims data were used in a decision analytic model to compare 12 scenarios for diagnostic management of suspected recurrent ipsilateral DVT. Estimated healthcare costs and mortality due to misdiagnosis, recurrent venous thromboembolism, and bleeding during first year of follow-up after presentation with suspected recurrence were compared. Results: All six scenarios including reference CUS had higher estimated one-year costs (€1763-€1913), than the six without reference CUS (€1192-€1474). Costs were higher because reference CUS results often remained unused, as 20% of patients (according to claims data) would return with suspected recurrent DVT. Estimated mortality was comparable in scenarios with (14.8-17.9 per 10,000 patients) and without reference CUS (14.0-18.5 per 10,000). None of the four potentially most desirable scenarios included reference CUS. Conclusions: One-year healthcare costs of diagnostic strategies for suspected recurrent ipsilateral DVT including reference CUS are higher compared to strategies without reference CUS, without mortality benefit. These results can inform policy-makers regarding use of healthcare resources during follow-up after DVT. From a cost-effectiveness perspective, the findings do not support the routine application of reference CUS.
AB - Background: The diagnosis of recurrent ipsilateral deep vein thrombosis (DVT) with compression ultrasonography (CUS) may be hindered by residual intravascular obstruction after previous DVT. A reference CUS, an additional ultrasound performed at anticoagulant discontinuation, may improve the diagnostic work-up of suspected recurrent ipsilateral DVT by providing baseline images for future comparison. Objectives: To evaluate the cost-effectiveness of routinely performing reference CUS in DVT patients. Methods: Patient-level data from a prospective management study (Theia study; NCT02262052) and claims data were used in a decision analytic model to compare 12 scenarios for diagnostic management of suspected recurrent ipsilateral DVT. Estimated healthcare costs and mortality due to misdiagnosis, recurrent venous thromboembolism, and bleeding during first year of follow-up after presentation with suspected recurrence were compared. Results: All six scenarios including reference CUS had higher estimated one-year costs (€1763-€1913), than the six without reference CUS (€1192-€1474). Costs were higher because reference CUS results often remained unused, as 20% of patients (according to claims data) would return with suspected recurrent DVT. Estimated mortality was comparable in scenarios with (14.8-17.9 per 10,000 patients) and without reference CUS (14.0-18.5 per 10,000). None of the four potentially most desirable scenarios included reference CUS. Conclusions: One-year healthcare costs of diagnostic strategies for suspected recurrent ipsilateral DVT including reference CUS are higher compared to strategies without reference CUS, without mortality benefit. These results can inform policy-makers regarding use of healthcare resources during follow-up after DVT. From a cost-effectiveness perspective, the findings do not support the routine application of reference CUS.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85178040201&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/37984402
U2 - 10.1055/a-2213-9230
DO - 10.1055/a-2213-9230
M3 - Article
C2 - 37984402
SN - 0340-6245
JO - Thrombosis and haemostasis
JF - Thrombosis and haemostasis
ER -