Abstract
Rapid quantitative D-dimer assays (DD), lower extremity venous duplex ultrasonography (US), and multislice computed tomographic (CT) angiography have been shown to have adequate sensitivities and specificities for diagnostic purpose. The purpose of this study was to evaluate cost-effectiveness of diagnostic strategies for pulmonary embolism (PE) in patients with a high, intermediate, or low clinical probability of PE. A formal cost-effectiveness analysis for the diagnosis of PE was performed. The main outcome measure for effectiveness was 3-month expected survival. The strategy of DD followed by CT was cost-effective and had the lowest cost per life saved for all patients suspected with PE. The conventional strategy including ventilation and perfusion lung scanning followed by pulmonary angiography (PA) or CT was not cost-effective. The leg US after CT was not also cost-effective. In clinical practice, the individual patient's condition should be considered when choosing appropriate diagnostic tests.
Highlights
Pulmonary embolism (PE) is a major health care concern affecting approximately 600 000 new patients each year in the United States.[1]
The results from this analysis using updated sensitivities and specificities for multislice computed tomographic (CT) angiography, lower extremity venous US, and rapid quantitative DD assays for the diagnosis of PE indicates that the strategy of DD + CT had the lowest cost per life saved in patients with a low, intermediate, or high clinical probability of PE
Its rather modest incremental cost per additional life saved indicates that US + CT could be the strategy of choice in patients with intermediate ($300 377 per additional life saved) or high ($124 815 per additional life saved) clinical probability of PE
Summary
Pulmonary embolism (PE) is a major health care concern affecting approximately 600 000 new patients each year in the United States.[1]. A wide variety of diagnostic strategies for PE have previously been evaluated using CEA methods;[2,3,4,5,6,7,8,9,10,11] but as the technology changes and the accuracy of diagnostic tests improves, CEAs need to be updated. More recent studies have used multislice CT improving the image quality for defining peripheral emboli; making CT more accurate in the diagnosis of PE.[12,13,14] The Second Prospective Investigation of PE Diagnosis (PIOPED II) reported a sensitivity of 83% and a specificity of 96% for the multislice spiral CT in determining subsegmental PE.[13]
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