Measurement of the clinical and cost-effectiveness of non-invasive diagnostic testing strategies for deep vein thrombosis

Abstract

Diagnostic algorithms based on a combination of Wells score, D-dimer and ultrasound (with repeat if negative) are feasible at most UK hospitals and are among the most cost-effective. Use of repeat scanning depends on the threshold for willingness to pay for health gain. Further diagnostic testing for patients with a low Wells score and negative D-dimer is unlikely to represent a cost-effective use of resources. Recommendations for research include the evaluation of the costs and outcomes of using the optimal diagnostic algorithms in routine practice, the development and evaluation of algorithms appropriate for specific groups of patients with suspected DVT, such as intravenous drug abusers, pregnant patients and those with previous DVT, the evaluation of the role of plethysmography: interaction with other diagnostic tests, outcome of low-risk patients with negative plethysmography and measurement of the costs of providing plethysmography, and methodological research into the incorporation of meta-analytic data into decision-analytic modelling.

Clinical effectiveness and cost-effectiveness of minimally invasive techniques to manage varicose veins: a systematic review and economic evaluation

“…The lifetime discounted costs and QALYs associated with DVT can be estimated from an economic analysis of diagnostic tests for DVT. 143 It reports the total lifetime QALYs and costs for persons suffering from DVT with different diagnostic testing scenarios (see Appendix 5 and table 44 in Goodacre et al 143 ). Total QALYs for a person with no DVT were 11.580, and with DVT 11.558 (scenarios 9 and 10, recommended in report as maximising net financial benefit, i.e.…”

Cost-effectiveness of edoxaban compared to warfarin for the treatment and secondary prevention of venous thromboembolism in the UK

“…The cost for the first month was estimated to be £168, corresponding to a first appointment for vascular surgery, and the average cost for each of the following months was estimated to be £23 per month, assuming 2 follow-up visits per year [27]. The costs related to CTEPH included treatment costs, surgery and drug therapy.…”

Duplex Ultrasonography Has Limited Utility in Detection of Postoperative DVT after Primary Total Joint Arthroplasty

“…The implicit assumption of surveillance testing is that a significant number of unexpected positive findings will be discovered. The National Health Service's Health Technology Assessment considers duplex ultrasound cost-effective when applied to patients with high clinical suspicion or findings of positive D-dimer or in patients with comorbidities that predispose to hypercoagulability [8]. However, the rate of positive tests when clinical suspicion exists for a DVT is not as well characterized.…”