Cost-effectiveness analysis of diagnostic strategies for suspected pulmonary embolism including helical computed tomography

Perrier, Arnaud; Nendaz, Mathieu; Sarasin, François; Howarth, Nigel; Bounameaux, Henri

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Title		Cost-effectiveness analysis of diagnostic strategies for suspected pulmonary embolism including helical computed tomography
Authors		Perrier, Arnaud Nendaz, Mathieu Sarasin, François Howarth, Nigel Bounameaux, Henri
Published in		American Journal of Respiratory and Critical Care Medicine. 2003, vol. 167, no. 1, p. 39-44
Abstract		We performed a formal decision analysis to evaluate the cost-effectiveness of various strategies for pulmonary embolism, including helical computed tomography (CT), and determined the most cost-effective schemes for each clinical probability of pulmonary embolism. Other tests included D-dimer (DD), lower limb venous ultrasound (US), ventilation-perfusion (V/Q) scan, and angiography. Outcome measures were 3-month survival and costs per patient managed. Baseline sensitivity of CT was 70%, corresponding to the performance of single-detector CT, and that figure was raised in sensitivity analysis to account for the expected higher sensitivity of newer multidetector CT scanners. All strategies were compared with a reference strategy, namely the V/Q scan in all patients followed when nondiagnostic by an angiogram. For low clinical probability patients, the most cost-effective strategy was DD, US, and V/Q scan, patients with a nondiagnostic V/Q scan being left untreated. Replacing V/Q scan by CT was also cost-effective. For intermediate and high clinical probability patients, a fourth test must be added, either CT or angiography in patients with nondiagnostic V/Q scan, or angiography in patients with a negative helical CT. When using sensitivity figures above 85% (in the multidetector range), DD, US, and CT became the most cost-effective strategy for all clinical probability categories. Helical CT as a single test was not cost-effective. In summary, including helical CT in diagnostic strategies for pulmonary embolism is cost-effective provided that it is combined with DD and US. In contrast, helical CT as a single test is not cost-effective.
Keywords		Angiography — Cost-Benefit Analysis — Decision Trees — Fibrin Fibrinogen Degradation Products — Humans — Leg — Pulmonary Embolism — Sensitivity and Specificity — Tomography, Spiral Computed — Ultrasonography — Ventilation-Perfusion Ratio
Identifiers		DOI: 10.1164/rccm.2106128 PMID: 14695108
Full text		Article - Limited access to UNIGE Other version: http://ajrccm.atsjournals.org/cgi/reprint/167/1/39.pdf
Structures		Faculté de médecine / Section de médecine clinique / Département de médecine interne des spécialités
Citation (ISO format)		PERRIER, Arnaud et al. Cost-effectiveness analysis of diagnostic strategies for suspected pulmonary embolism including helical computed tomography. In: American Journal of Respiratory and Critical Care Medicine, 2003, vol. 167, n° 1, p. 39-44. https://archive-ouverte.unige.ch/unige:7978