Summary Essentials A venous thromboembolism (VTE) diagnostic strategy is economical compared to imaging alone.Applied a VTE diagnostic strategy to a D‐dimer multicenter study for cost‐minimization analysis.Average diagnostic test costs for patients were significantly lower with a diagnostic strategy.Implementation of a VTE diagnostic strategy reduces the diagnostic costs for a hospital. BackgroundThe burden of healthcare costs has substantially risen in the last few decades. One possible contributing factor to this increase are the diagnostic approaches for venous thromboembolism (VTE) using only imaging to exclude a diagnosis of VTE.ObjectiveTo demonstrate cost minimization in the diagnosis of VTE by comparing standalone imaging (computed tomography pulmonary angiography and compression ultrasonography) to a published VTE diagnostic strategy incorporating assessment of pre‐test probability and D‐dimer testing.MethodsWe retrospectively reviewed data from a multicenter diagnostic accuracy study of a D‐dimer reagent where consecutive outpatients (n=747) with suspected VTE, including both pulmonary embolism (n=346) and deep venous thrombosis (n=401) were evaluated. By applying a VTE diagnostic strategy and using the proportion of patients that were diagnosed as VTE‐negative (n=137 for PE; n=120 for DVT), we developed a cost calculator to compare the average diagnostic test cost per suspected VTE patient, both before and after the implementation of the VTE diagnostic strategy.ResultsImplementation of the VTE diagnostic strategy reduced the average diagnostic test cost for a suspected PE patient by 38% and for a suspected DVT patient by 24%. Assuming the proportion of VTE suspected patients to be 30% PE and 70% DVT, the weighted average reduction in the diagnostic test cost per suspected VTE patient was 32%.ConclusionImplementation of a VTE diagnostic strategy can allow hospitals to reduce costs without compromising patient safety.

diagnostic scenarios resulted in more QALYs and fewer total costs compared to a standard test (dominant ICERs). The greatest benefit was among adults 18-64 using the smartphone-enhanced test at a pharmacy during the off-season for flu (INMB = $124 per person). Most QALY gains were by avoiding treatment side effects in people with non-flu illnesses. Patients benefitted by avoiding productivity loss and payers were predicted to avoid costs of unnecessary drugs and side effects. ConClusions: This economic decision model of a smartphone-enhanced influenza diagnostic projects that the new product could in result cost savings, health gains, and greatest value for patients aged 18-64 when administered in a pharmacy or at home during the off-season for flu.