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

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

doi:10.1055/a-2213-9230

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2024; 124(06): 557-567
DOI: 10.1055/a-2213-9230

Stroke, Systemic or Venous Thromboembolism

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

Cindy M. M. de Jong

¹Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands

,

Wilbert B. van den Hout

²Department of Biomedical Data Sciences - Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands

,

Christel E. van Dijk

³National Health Care Institute, The Netherlands

,

Noor Heim

³National Health Care Institute, The Netherlands

,

Lisette F. van Dam

¹Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands

⁴Department of Emergency Medicine, Haga Teaching Hospital, The Hague, The Netherlands

,

Charlotte E. A. Dronkers

¹Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands

,

Gargi Gautam

⁵Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden

,

Waleed Ghanima

⁶Department of Internal Medicine, Østfold Hospital Trust, Gralum, Norway

⁷Department of Haematology, Institute of Clinical Medicine, University of Oslo, Oslo, Norway

,

Jostein Gleditsch

⁸Department of Radiology, Østfold Hospital Trust, Gralum, Norway

,

Anders von Heijne

⁵Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden

,

Herman M. A. Hofstee

⁹Department of Internal Medicine, Haaglanden Medical Center, The Hague, The Netherlands

,

Marcel M. C. Hovens

¹⁰Department of Vascular Medicine, Rijnstate Hospital, Arnhem, The Netherlands

,

Menno V. Huisman

¹Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands

,

Stan Kolman

¹¹Department of Vascular Medicine, Diakonessen Hospital, Utrecht, The Netherlands

,

Albert T. A. Mairuhu

¹²Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands

,

Thijs E. van Mens

¹Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands

,

Mathilde Nijkeuter

¹³Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands

,

Marcel A. van de Ree

¹¹Department of Vascular Medicine, Diakonessen Hospital, Utrecht, The Netherlands

,

Cornelis J. van Rooden

¹⁴Department of Radiology, Haga Teaching Hospital, The Hague, The Netherlands

,

Robin E. Westerbeek

¹⁵Department of Radiology, Deventer Hospital, Deventer, The Netherlands

,

Jan Westerink

¹⁶Department of Internal Medicine, Isala Hospital, Zwolle, The Netherlands

,

Eli Westerlund

⁵Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden

,

Lucia J. M. Kroft

¹⁷Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands

,

Frederikus A. Klok

¹Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands

› Institutsangaben

Abstract

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.

Keywords

cost-effectiveness analysis - deep vein thrombosis - diagnostic imaging - recurrence - ultrasonography

Volltext

Referenzen

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