title: International differences in health care costs in Europe and the United States: Do these affect the cost-effectiveness of diagnostic strategies for pulmonary embolism?
abstract: The aim of this study was to assess whether potential differences in costs for diagnostic procedures and treatment of pulmonary embolism (PE) among European and U. S. hospitals alter the optimal cost-effective diagnostic strategy for PE. A standardized questionnaire was used to obtain cost data for the diagnosis and treatment of PE in participating European and U. S. hospitals. Costs for diagnostic tests and treatment of PE were then calculated in a standardized manner for all participating hospitals, from the hospital perspective. Costs were used in an existing cost-effectiveness analysis (CEA) model to determine the most cost-effective diagnostic strategy in participating hospitals. There were considerable differences in costs for diagnostic and therapeutic procedures for PE among the participating centers. These differences, however, did not affect the most cost-effective strategy based on incremental cost-effectiveness. In all hospitals the most cost-effective strategy appeared to be ultrasound followed by helical CT. International differences in cost of diagnostic and therapeutic procedures certainly exist and should be considered before applying a published CEA. Nevertheless, despite these cost differences, the diagnostic strategy for PE of ultrasound followed by helical CT appears most cost-effective.
authors.affiliation: Department of Radiology, Leiden University Medical Center, Albinusdreef 2, P. O. Box 9600, NL-2300 RC Leiden, The Netherlands.
authors.forename: A R
authors.initials: AR
authors.lastname: van Erkel
authors.forename: W B
authors.initials: WB
authors.lastname: van den Hout
authors.forename: P M
authors.initials: PM
authors.lastname: Pattynama
mesh_terms: D000792:Angiography / Q000191:economics / Q000592:standards; D003362:Cost-Benefit Analysis; D005060:Europe; D005343:Fibrinolytic Agents / Q000191:economics / Q000627:therapeutic use; D014943:Global Health; D017048:Health Care Costs; D006801:Humans; D011379:Prognosis; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics*; D011795:Surveys and Questionnaires; D015912:Thrombolytic Therapy / Q000191:economics; D015899:Tomography, Emission-Computed, Single-Photon / Q000191:economics*; D014057:Tomography, X-Ray Computed / Q000191:economics*; D014463:Ultrasonography / Q000191:economics* / Q000592:standards; D014481:United States
chemical_list: D005343:Fibrinolytic Agents