title: [Cost effectiveness of Doppler-echocardiography in the diagnosis of deep venous thrombosis of the lower limbs. Theoretical calculation from a prospective series of 511 patients].
abstract: The management of deep venous thrombosis has non-negligible financial implications due not only to the high frequency of clinical suspicion--and therefore to the methods used a positive diagnosis--but also to the overall cost of management. To evaluate the expenditure incurred for the diagnostic tests, 511 patients suspected of deep venous lower limb thrombosis were examined clinically, then by Duplex ultrasonography combined with plethysmography. Whenever a suspected phlebitis was detected by this method, or at random if it was not, phlebography was performed. The 185 phlebography/ultrasonography comparisons enabled us to extrapolate the results obtained to all 511 patients and thus to compare the theoretical cost of 4 decisional algorithms according to the diagnostic criteria utilized. Our conclusions were as follows: the clinical diagnosis alone is not cost-effective, whereas Duplex ultrasonography is reliable and, compared with phlebography, saves more than 1,500,000 francs per year, including 1,000,000 francs saved on the global hospital budget in France. Phlebography used in each proximal venous thrombosis for accurate localization of the upper end of the clot does not significantly increase the cost: the annual savings on systematic phlebography are still above 1,200,000 francs, including 800,000 francs to the benefit of public hospitals.
authors.affiliation: Service d'Angiologie du CHU Rangueil, Toulouse.
authors.forename: P
authors.initials: P
authors.lastname: Bendayan
authors.forename: H
authors.initials: H
authors.lastname: Boccalon
mesh_terms: D000465:Algorithms; D003362:Cost-Benefit Analysis; D015150:Echocardiography, Doppler; D005340:Fibrinogen; D005602:France; D006779:Hospitals, Public / Q000191:economics*; D006801:Humans; D010690:Phlebography; D010991:Plethysmography; D011446:Prospective Studies; D013927:Thrombosis / Q000175:diagnosis / Q000000981:diagnostic imaging*
chemical_list: D005340:Fibrinogen
vernacular_title: Rentabilité économique de l'échographie Doppler dans le diagnostic des thromboses veineuses profondes des membres inférieurs. Calcul théorique à partir d'une série prospective de 511 patients.