Cost-effectiveness of magnetic resonance imaging for diagnosing recurrent ipsilateral deep vein thrombosis

Dam, Lisette F. van; Hout, Wilbert B. van den; Gautam, Gargi; Dronkers, C.E.A.; Ghanima, Waleed; Gleditsch, Jostein; Heijne, Anders von; Hofstee, H.M.A.; Hovens, Marcel M.C.; Huisman, Menno V.; Kolman, Stan; Mairuhu, Albert T.A.; Nijkeuter, Mathilde; Ree, Marcel A. van de; Rooden, Cornelis J. van; Westerbeek, Robin E.; Westerink, Jan; Westerlund, Eli; Kroft, Lucia J.M.; Klok, Frederikus A.

doi:10.1182/bloodadvances.2020003849

Cited by 4 publications

(15 citation statements)

References 39 publications

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“…We identified 1 model-based cost-effectiveness analysis on the diagnosis of recurrent ipsilateral DVT. 44 This analysis compared different diagnostic strategies including a clinical decision rule, d -dimer test, compression ultrasound, and magnetic resonance direct thrombus imaging (MRDTI). The analysis was based on a prospective cohort with 234 patients and the prevalence of recurrent DVT was 43%.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2022

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Guideline developers consider cost-effectiveness evidence in decision making to determine value for money. This consideration in the guideline development process can be informed either by formal and dedicated economic evaluations or by systematic reviews of existing studies. To inform the American Society of Hematology guideline on the diagnosis of venous thromboembolism (VTE), we conducted a systematic review focused on the cost-effectiveness of diagnostic strategies for VTE within the guideline scope. We systematically searched Medline (Ovid), Embase (Ovid), National Health Service Economic Evaluation Database, and the Cost-effectiveness Analysis Registry, summarized, and critically appraised the economic evidence on diagnostic strategies for VTE. We identified 49 studies that met our inclusion criteria, with 26 on pulmonary embolism (PE) and 24 on deep vein thrombosis (DVT). For the diagnosis of PE, strategies including D-dimer to exclude PE were cost-effective compared to strategies without D-dimer testing. The cost-effectiveness of CT pulmonary angiogram (CTPA) in relation to ventilation-perfusion (V/Q) scan was inconclusive. CTPA or V/Q scan following ultrasound or D-dimer results could be cost-effective or even cost saving. For DVT, studies supporting strategies with D-dimer and/or ultrasound were cost-effective, supporting the recommendation that for patients at low (unlikely) VTE risk, using D-dimer as the initial test reduces the need for diagnostic imaging. Our systematic review informed the ASH guideline recommendations about D-dimer, V/Q scan and CTPA for PE diagnosis and D-dimer and ultrasound for DVT diagnosis.

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Section: Resultsmentioning

confidence: 99%

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

et al. 2022

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“…MRDTI scanning could provide the solution to achieve an ultimate diagnosis and guide clinical decision-making in such situations, as MRDTI was both shown to be an accurate and reproducible diagnostic test and as its application would not lead to higher costs when compared with performing CUS only. 6,19 When MRDTI is not (routinely) available, a strategy of performing reference CUS for high-risk patients who stop anticoagulant treatment may be reasonable. With the current model and data, we could not explore this scenario.…”

Section: Discussionmentioning

confidence: 99%

“…The results of CUS were defined as either abnormal or normal in the scenarios in which there was no reference CUS performed or in case reference CUS was unavailable. 19 Twelve scenarios were included in the decision analytic model: three scenarios consisted of a diagnostic imaging test only, three included a combination of diagnostic imaging tests, and six combined CDR assessment and D-dimer testing with diagnostic imaging tests.…”

Section: Diagnostic Scenariosmentioning

confidence: 99%

“…18 In accordance with the previous cost-effectiveness analysis of the Theia study, a positive CUS was defined as a new noncompressible segment or a !2-4 mm increase in vein diameter of a previously noncompressible venous segment when compared to a reference CUS. 19 A negative CUS was defined as the absence of a noncompressible segment, or the absence of a new noncompressible segment in comparison with a reference CUS and/or a <2 mm increase in the vein diameter of a previously noncompressible vein. 19 An inconclusive CUS was defined as one or more noncompressible venous segment(s), when recurrent DVT could not be diagnosed or excluded despite a performed and available reference CUS for comparison.…”

Section: Definitionsmentioning

confidence: 99%

“…19 A negative CUS was defined as the absence of a noncompressible segment, or the absence of a new noncompressible segment in comparison with a reference CUS and/or a <2 mm increase in the vein diameter of a previously noncompressible vein. 19 An inconclusive CUS was defined as one or more noncompressible venous segment(s), when recurrent DVT could not be diagnosed or excluded despite a performed and available reference CUS for comparison. A normal CUS was defined as full compressibility along the venous system; an abnormal CUS was defined as one or more noncompressible venous segments.…”

Section: Definitionsmentioning

confidence: 99%

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Cost-Effectiveness of Performing Reference Ultrasonography in Patients with Deep Vein Thrombosis

de Jong,

van den Hout,

van Dijk

et al. 2023

Thromb Haemost

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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 (n = 96) 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 health care costs and mortality due to misdiagnosis, recurrent venous thromboembolism, and bleeding during the first year of follow-up after presentation with suspected recurrence were compared. Results All six scenarios including reference CUS had higher estimated 1-year costs (€1,763–€1,913) than the six without reference CUS (€1,192–€1,474). 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. Conclusion One-year health care 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 health care resources during follow-up after DVT. From a cost-effectiveness perspective, the findings do not support the routine application of reference CUS.

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Use of Magnetic Resonance Direct Thrombus Imaging for the Diagnostic Management of Suspected Thrombosis in Routine Clinical Practice

de Jong,

van Dam,

Dronkers

et al. 2024

TH Open

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Background: The non-invasive magnetic resonance direct thrombus imaging (MRDTI) technique can be used to diagnose acute deep-vein thrombosis (DVT), without the use of intravenous contrast. MRDTI holds the potential to differentiate between acute and chronic DVT and could be helpful when diagnosing thrombosis is challenging. Objectives: To evaluate the application of MRDTI in clinical practice, including the frequency and indications of MRDTI scans performed in practice based conditions, results, impact on treatment decisions, and associated patient outcomes. Methods: A retrospective study was performed at the Leiden University Medical Center, the Netherlands. MRDTI scans performed since its implementation in patients aged ≥18 years as part of clinical practice for diagnostic management of suspected thrombosis were evaluated. Results: Between October 2015 and September 2023, 36 patients had undergone MRDTI for the diagnostic evaluation of thrombosis. MRDTI application increased since 2019 (5 to 8 scans per year). The most common indication was to differentiate between acute and chronic thrombosis, mainly for suspected recurrent ipsilateral DVT after inconclusive compression ultrasonography. In over a third of patients, acute thrombosis was confirmed by MRDTI. MRDTI results determined treatment decisions in all except two patients. One patient had symptomatic thrombosis of the lower extremity within 3 months after an MRDTI of the upper extremity without signs of acute thrombosis (1/23; 4.3%, 95% confidence interval 0.77-21). Conclusion: Over the past 4 years, MRDTI has been used increasingly in our hospital. MRDTI results guided treatment decisions, which confirms the clinical impact and feasibility of its application in daily practice.

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Cost-effectiveness of magnetic resonance imaging for diagnosing recurrent ipsilateral deep vein thrombosis

Cited by 4 publications

References 39 publications

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

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

Cost-Effectiveness of Performing Reference Ultrasonography in Patients with Deep Vein Thrombosis

Use of Magnetic Resonance Direct Thrombus Imaging for the Diagnostic Management of Suspected Thrombosis in Routine Clinical Practice

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