TY - JOUR
T1 - Cost-effectiveness of ruling out deep venous thrombosis in primary care versus care as usual
AU - ten Cate-Hoek, A. J.
AU - Toll, D. B.
AU - Büller, H. R.
AU - Hoes, A. W.
AU - Moons, K. G. M.
AU - Oudega, R.
AU - Stoffers, H. E. J. H.
AU - van der Velde, E. F.
AU - van Weert, H. C. P. M.
AU - Prins, M. H.
AU - Joore, M. A.
PY - 2009
Y1 - 2009
N2 - Background: Referral for ultrasound testing in all patients suspected of DVT is inefficient, because 80-90% have no DVT. Objective: To assess the incremental cost-effectiveness of a diagnostic strategy to select patients at first presentation in primary care based on a point of care D-dimer test combined with a clinical decision rule (AMUSE strategy), compared with hospital-based strategies. Patients/Methods: A Markov-type cost-effectiveness model with a societal perspective and a 5-year time horizon was used to compare the AMUSE strategy with hospital-based strategies. Data were derived from the AMUSE study (2005-2007), the literature, and a direct survey of costs (2005-2007). Results of base-case analysis: Adherence to the AMUSE strategy on average results in savings of euro138 ($185) per patient at the expense of a very small health loss (0.002 QALYs) compared with the best hospital strategy. The iCER is euro55 753($74 848). The cost-effectiveness acceptability curves show that the AMUSE strategy has the highest probability of being cost-effective. Results of sensitivity analysis: Results are sensitive to decreases in sensitivity of the diagnostic strategy, but are not sensitive to increase in age (range 30-80), the costs for health states, and events. Conclusion: A diagnostic management strategy based on a clinical decision rule and a point of care D-dimer assay to exclude DVT in primary care is not only safe, but also cost-effective as compared with hospital-based strategies
AB - Background: Referral for ultrasound testing in all patients suspected of DVT is inefficient, because 80-90% have no DVT. Objective: To assess the incremental cost-effectiveness of a diagnostic strategy to select patients at first presentation in primary care based on a point of care D-dimer test combined with a clinical decision rule (AMUSE strategy), compared with hospital-based strategies. Patients/Methods: A Markov-type cost-effectiveness model with a societal perspective and a 5-year time horizon was used to compare the AMUSE strategy with hospital-based strategies. Data were derived from the AMUSE study (2005-2007), the literature, and a direct survey of costs (2005-2007). Results of base-case analysis: Adherence to the AMUSE strategy on average results in savings of euro138 ($185) per patient at the expense of a very small health loss (0.002 QALYs) compared with the best hospital strategy. The iCER is euro55 753($74 848). The cost-effectiveness acceptability curves show that the AMUSE strategy has the highest probability of being cost-effective. Results of sensitivity analysis: Results are sensitive to decreases in sensitivity of the diagnostic strategy, but are not sensitive to increase in age (range 30-80), the costs for health states, and events. Conclusion: A diagnostic management strategy based on a clinical decision rule and a point of care D-dimer assay to exclude DVT in primary care is not only safe, but also cost-effective as compared with hospital-based strategies
U2 - https://doi.org/10.1111/j.1538-7836.2009.03627.x
DO - https://doi.org/10.1111/j.1538-7836.2009.03627.x
M3 - Article
C2 - 19793189
SN - 1538-7933
VL - 7
SP - 2042
EP - 2049
JO - Journal of thrombosis and haemostasis
JF - Journal of thrombosis and haemostasis
IS - 12
ER -