en
Scientific article
English

Age-adjusted D-dimer cutoff for the diagnosis of pulmonary embolism: A cost-effectiveness analysis

Published inJournal of thrombosis and haemostasis, vol. 18, no. 4, p. 865-875
Publication date2020-04
First online date2020-01-10
Abstract

Background: In patients with suspected pulmonary embolism (PE) and a non-high pretest probability, the use of an age-adjusted D-dimer cutoff (AADD, <500 ng/mL up to 50 years, then

Methods: We created a decision tree to compare the use of the AADD with the standard D-dimer cutoff. The model included short-term venous thromboembolism-related events and long-term complications, their associated morbidity/mortality, and costs. Probabilities were derived from published literature and the ADJUST-PE study, and costs from US estimates. The time horizon was lifetime, with a health care system perspective.

Results: Using the AADD cutoff, compared with the standard cutoff, was associated with a loss of 0.0001 quality-adjusted life-years (QALY) and an average cost reduction of $33.4. The decremental cost-effectiveness ratio (DCER) was +$282 881/lost QALY (95% confidence interval from +$43 209/lost QALY to a dominant strategy). The probability that the use of the AADD cutoff was either dominant or gained >$200 000/lost QALY was 79.4%. In sensitivity analyses, the DCER became <+$200 000/lost QALY only if, among patients with D-dimer below the AADD cutoff, the mortality of an undiagnosed PE was >6% or the prevalence of PE was >0.6%.

Conclusions: The AADD cutoff results in a clinically nonsignificant decrease in QALY but important costs reductions. It is a decrementally cost-effective innovation, with a potential of cost savings of >$80 million per year for the United States health care system.

eng
Keywords
  • Biomarker
  • Cost-benefit analysis
  • Diagnosis
  • Fibrin fragment D
  • Pulmonary embolism
  • Angiography
  • Cost-Benefit Analysis
  • Fibrin Fibrinogen Degradation Products
  • Humans
  • Pulmonary Embolism / diagnosis
Citation (ISO format)
BLONDON, Marc et al. Age-adjusted D-dimer cutoff for the diagnosis of pulmonary embolism: A cost-effectiveness analysis. In: Journal of thrombosis and haemostasis, 2020, vol. 18, n° 4, p. 865–875. doi: 10.1111/jth.14733
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Identifiers
ISSN of the journal1538-7836
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