Pregnancy-Adapted YEARS Algorithm for Diagnosing Suspected Pulmonary Embolism: A Cost-Effectiveness Analysis [29L

Abstract

INTRODUCTION: A recent large prospective study found the pregnancy-adapted YEARS algorithm to be an effective screening tool for pregnant women with suspected pulmonary embolism (PE) while reducing the number of CT pulmonary angiography (CTPA). We investigated the cost-effectiveness of using the YEARS algorithm compared to the current standard. METHODS: A cost-effectiveness model was built using TreeAge software to compare the YEARS algorithm versus the current standard where all women get a CTPA. We used a theoretical cohort of 35,000 women, the estimated number of pregnant women in the US who are evaluated for a PE each year. Outcomes included costs, quality-adjusted life years (QALY’s) for the mother, maternal death, childhood cancer, and missed PE’s. Probabilities were derived from the literature. Cost-effectiveness threshold was set at $100,0000/QALY. Sensitivity analyses were done to evaluate the robustness of the results. RESULTS: In our theoretical cohort, the pregnancy-adapted YEARS algorithm resulted in a savings of $5,923,530 per year and higher QALYs. There were 42 fewer cases of childhood cancer and 4 more maternal deaths despite 361 missed PE cases. CONCLUSION: In our theoretical cohort, utilizing the pregnancy-adapted YEARS algorithm resulted in lower costs and increased QALYs. These results should be considered as future guidelines regarding the evaluation of pregnant women with suspected PE’s are established.