Cost‐minimization analysis of venous thromboembolism diagnosis: Comparison of standalone imaging with a strategy incorporating D‐dimer for exclusion of venous thromboembolism

Abstract

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.

Age‐adjusted D‐dimer cut‐off levels to rule out venous thromboembolism in patients with non‐high pre‐test probability: Clinical performance and cost‐effectiveness analysis

“…Cost reduction would have been even higher in other countries like the United States with calculations made from local estimates. 45 In that connection, Blondon et al evaluated the cost effectiveness of such a strategy by using a decision tree aimed at simulating the diagnosis strategy of PE and relevant present and future outcomes in a cohort of patients with a non-high PTP of PE with a life-term horizon and a health-care system perspective. They concluded that the use of an age-adjusted cut-off resulted in a clinically non-significant decrease in quality-adjusted life-years (QALY) but important cost reductions of above $80 million per year for the US health-care system.…”

“…Moreover, based on the reimbursement costs of D‐dimer, CTPA, and CUS in France, this strategy was found to be cost effective in the validation cohort, with a 6.9% reduction in diagnostic costs for PE and a 5.1% reduction in diagnostic costs for DVT, compared to the conventional strategy. Cost reduction would have been even higher in other countries like the United States with calculations made from local estimates 45 . In that connection, Blondon et al evaluated the cost effectiveness of such a strategy by using a decision tree aimed at simulating the diagnosis strategy of PE and relevant present and future outcomes in a cohort of patients with a non‐high PTP of PE with a life‐term horizon and a health‐care system perspective.…”

“…The cost effectiveness of the diagnostic strategies was evaluated in the validation cohort, by taking into account the reimbursement costs of D‐dimer testing, CTPA, and CUS in France (€16.20, €58.72, and €75.60, respectively), and in the United States (US$648, US$226, and US$14, respectively) 45 . Analysis was based on the assumption that D‐dimer was prescribed to all patients with non‐high PTP and imaging tests performed only when the test result was above the cut‐off level.…”

Performance Evaluation of the Quantitative Point-of-Care LumiraDx d-Dimer Test

“…The associated cost reduction of successfully implementing a VTE diagnostic strategy involving initial clinical assessment versus imaging alone was found to be 38% for patients with suspected PE and 24% for suspected DVT. Assuming the proportion of suspected PE and DVT patients to be 30% and 70%, respectively, the weighted average cost reduction per suspected VTE patient was 32% [6].…”

Cost-minimization modeling of venous thromboembolism diagnostics: performing limited compression ultrasound in primary health care reduces costs compared to referring patients to a hospital

“…A cost-effectiveness analysis on multiple different diagnostic strategies in a hospital has been previously performed [ 18 , 19 ]. Verma et al conducted a cost-minimization analysis and found that incorporating a D-dimer assessment into the diagnostic protocol in hospital setting instead of referring every DVT patient to US saved 24% of costs [ 20 ]. We are not aware of any studies which have estimated the overall costs of the LCUS protocol.…”