Cost-effectiveness of diagnostic strategies for venous thromboembolism: a systematic review

Zhang, Yuan; Begum, Housne; Grewal, Himmat; Etxeandia-Ikobaltzeta, Itziar; Morgano, Gian Paolo; Khatib, Rasha; Nieuwlaat, Robby; Ding, Chengyuan; Wiercioch, Wojtek; Mustafa, Reem A.; Lim, Wendy; Schünemann, Holger J.

doi:10.1182/bloodadvances.2020003576

Cited by 13 publications

(6 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, cost-effectiveness studies of PE diagnostic strategies that primarily considered (age-adjusted) D-dimer threshold or (age-adjusted) D-dimer threshold with other strategies for PE have been conducted. It has been reported that the diagnostic strategies with age-adjusted D-dimer to rule out PE were cost-effective compared with strategies without D-dimer testing (15). Although the YEARS strategy has been associated with emergency room resource use reductions (16), no formal evaluation of its effectiveness and costs has been made until now.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of MOdified DIagnostic strateGy to safely ruLe-out pulmonary embolism in the emergency depArtment: A Non-Inferiority cluster crossover randomized trial (MODIGLIA- NI)

OSSIMA¹,

SIAHA²,

Mimouni³

et al. 2023

Preprint

View full text Add to dashboard Cite

Background: The aim of this trial-based economic evaluation was to assess the incremental costs and cost-effectiveness of the modified diagnostic strategy combining the YEARS rule and age-adjusted D-dimer threshold compared with the control (which used the age-adjusted D-dimer threshold only) for the diagnosis of pulmonary embolism (PE) in the Emergency Department (ED). Methods: Economic evaluation from a healthcare system perspective alongside a non-inferiority, crossover, and cluster-randomized trial conducted in 16 EDs in France and two in Spain with three months of follow-up. The primary endpoint was the additional cost of a patient without failure of the diagnostic strategy, defined as venous thromboembolism (VTE) diagnosis at 3months after exclusion of PE during the initial ED visit. Mean differences in 3-month failure and costs were estimated using mixed linear regression models, adjusted for strategy type, period, and the interaction between strategy and period as fixed effects and the hospital as a random effect. The incremental cost-effectiveness ratio (ICER) was obtained by dividing the incremental costs by the incremental frequency of VTE. Results: Of the 1414 included patients, 1217 (86%) were analyzed in the per-protocol analysis (648 in the intervention group and 623 in the control group). At three month, there were no statistically significant differences in total costs (€-47; 95% CI: €-103 to €4), and the failure rate was non inferior in the intervention group (-0.64%, one-sided 97.5% CI: -∞ to 0.21%, non-inferiority margin 1.5%) between groups. The point estimate of the incremental cost-effectiveness ratio (ICER) calculated that each patient without diagnostic failure was associated with cost savings of €7,343 in the intervention strategy compared with the controls. There was a 90% probability that the intervention was dominant. Similar results were found in the as randomized population. Conclusions: This trial suggests that there is an economic advantage to using the YEARS rule combined with the PERC rule and the age-adjusted D-dimer threshold in PERC-positive patients, as this strategy is non-inferior and less costly than the standard diagnostic strategy. Trial registration number ClinicalTrials.gov Identifier: NCT04032769; July 25, 2019

show abstract

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of MOdified DIagnostic strateGy to safely ruLe-out pulmonary embolism in the emergency depArtment: A Non-Inferiority cluster crossover randomized trial (MODIGLIA- NI)

OSSIMA¹,

SIAHA²,

Mimouni³

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Furthermore, this selective intervention method may have cost-effective advantages. Recent systematic reviews showed that the combination of D-dimer and US are cost-effective method for the diagnosis of DVT [ 27 , 28 ]. However, D-dimer is usually used to rule-out DVT, and if positive, it is not the criterion for selecting patients to be treated.…”

Section: Discussionmentioning

confidence: 99%

Fibrin monomer complex on postoperative day 1 is correlated with the volume of deep vein thrombosis after knee surgery

et al. 2022

View full text Add to dashboard Cite

Purpose Patients undergoing knee surgery are at high risk for deep vein thrombosis (DVT), which is infrequent but potentially life-threatening. It has not been identified how to efficiently detect high-risk DVT while minimizing bleeding complications from anticoagulation. We hypothesized that the degree of activation of thrombotic markers may correlate with the size of the thrombus. Therefore, we investigated the correlation between thrombotic markers and DVT thrombus volume in patients after knee surgery. Methods This retrospective study involved 29 patients who underwent around knee osteotomy or total / unicompartmental knee arthroplasty from 2018 to 2020. Fibrin monomer complex (FMC) at 1, and 7 days after surgery, and D-dimer at 4, and 7 days after surgery were investigated. In addition, the volume of DVT was estimated with ultrasonography at the 7 days after surgery. Body mass index, surgical time, and total volume of blood loss were also evaluated. Factors related to thrombus volume were examined statistically. Results Nine patients (31.0%) exhibited asymptomatic distal DVT, whereas 1 patient (3.4%) experienced asymptomatic proximal DVT. No patients had pulmonary embolism. Statistical analysis showed that only FMC concentration on postoperative day 1 was significantly correlated with thrombus volume (p < 0.001, 95% confidence interval 0.41 to 0.839, r = 0.679). Conclusions The FMC concentration was a useful early indicator of deep vein thrombosis after knee surgery. Monitoring the FMC concentration could enable selective identification of patients with a high thrombus volume, which is associated with a high risk for pulmonary embolism.

show abstract

“…The uncertainty surrounding these point estimates was examined using a two-stage non-parametric bootstrapping technique with 1,000 replications [ 14 ]. This method explicitly accounts for the correlation and clustering in the hierarchical cost and effect data.…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of modified diagnostic strategy to safely rule-out pulmonary embolism in the emergency department: a non-inferiority cluster crossover randomized trial (MODIGLIA-NI)

Nze Ossima,

Ngaleu Siaha,

Mimouni

et al. 2023

BMC Emerg Med

View full text Add to dashboard Cite

Background The aim of this trial-based economic evaluation was to assess the incremental costs and cost-effectiveness of the modified diagnostic strategy combining the YEARS rule and age-adjusted D-dimer threshold compared with the control (which used the age-adjusted D-dimer threshold only) for the diagnosis of pulmonary embolism (PE) in the Emergency Department (ED). Methods Economic evaluation from a healthcare system perspective alongside a non-inferiority, crossover, and cluster-randomized trial conducted in 16 EDs in France and two in Spain with three months of follow-up. The primary endpoint was the additional cost of a patient without failure of the diagnostic strategy, defined as venous thromboembolism (VTE) diagnosis at 3months after exclusion of PE during the initial ED visit. Mean differences in 3-month failure and costs were estimated using separate generalized linear-regression mixed models, adjusted for strategy type, period, and the interaction between strategy and period as fixed effects and the hospital as a random effect. The incremental cost-effectiveness ratio (ICER) was obtained by dividing the incremental costs by the incremental frequency of VTE. Results Of the 1,414 included patients, 1,217 (86%) were analyzed in the per-protocol analysis (648 in the intervention group and 623 in the control group). At three months, there were no statistically significant differences in total costs (€-46; 95% CI: €-93 to €0.2), and the failure rate was non inferior in the intervention group (-0.64%, one-sided 97.5% CI: -∞ to 0.21%, non-inferiority margin 1.5%) between groups. The point estimate of the incremental cost-effectiveness ratio (ICER) indicating that each undetected VTE averted in the intervention group is associated with cost savings of €7,142 in comparison with the control group. There was a 93% probability that the intervention was dominant. Similar results were found in the as randomized population. Conclusions Given the observed cost decrease of borderline significance, and according to the 95% confidence ellipses, the intervention strategy has a potential to lead to cost savings as a result of a reduction in the use of chest imaging and of the number of undetected VTE averted. Policy-makers should investigate how these monetary benefits can be distributed across stakeholders. Clinicaltrials Trial registration number ClinicalTrials.gov Identifier: NCT04032769; July 25, 2019.

show abstract

Cost-effectiveness of diagnostic strategies for venous thromboembolism: a systematic review

Cited by 13 publications

References 49 publications

Cost-effectiveness of MOdified DIagnostic strateGy to safely ruLe-out pulmonary embolism in the emergency depArtment: A Non-Inferiority cluster crossover randomized trial (MODIGLIA- NI)

Cost-effectiveness of MOdified DIagnostic strateGy to safely ruLe-out pulmonary embolism in the emergency depArtment: A Non-Inferiority cluster crossover randomized trial (MODIGLIA- NI)

Fibrin monomer complex on postoperative day 1 is correlated with the volume of deep vein thrombosis after knee surgery

Cost-effectiveness of modified diagnostic strategy to safely rule-out pulmonary embolism in the emergency department: a non-inferiority cluster crossover randomized trial (MODIGLIA-NI)

Contact Info

Product

Resources

About