Optimal management strategy for use of compression US for deep venous thrombosis in symptomatic patients: a cost-effectiveness analysis.
OBJECTIVE
The authors' purpose was to identify the optimal strategy for using compression ultrasonography (US) in patients suspected of having deep venous thrombosis (DVT).


METHODS
The authors developed a decision-analytic model representing the natural history of DVT and the benefits and risks of anticoagulation therapy. They evaluated six initial imaging strategies: (a) unilateral examination of the common femoral and popliteal veins; (b) unilateral examination of the common femoral, popliteal, and femoral veins; (c) bilateral examination of the common femoral and popliteal veins; (d) bilateral examination of the common femoral, popliteal, and femoral veins; (e) complete unilateral examination of the symptomatic leg (including calf veins); and (f) complete bilateral examination of both legs.


RESULTS
For 65-year-old men with unilateral symptoms of DVT, the most effective strategy was bilateral examination of the common femoral and popliteal veins with anticoagulation therapy in patients with proximal DVT and follow-up bilateral examination of the common femoral and popliteal veins in patients without an initial diagnosis of DVT with an incremental cost-effectiveness ratio of $39,000 per quality-adjusted life year gained.


CONCLUSIONS
These results suggest that bilateral examination limited to the common femoral and popliteal veins, with follow-up bilateral examination limited to the common femoral and popliteal veins, was as cost-effective as other well-accepted medical interventions. The results were sensitive to the distribution of clot, diagnostic accuracy of compression US, and probability of bleeding with long-term morbidity.
Kim
H M
HM
Center for Statistical Consultation and Research, Rackham, University of Michigan, Ann Arbor 48109-1070, USA.
Kuntz
K M
KM
Cronan
J J
JJ
D000368:Aged; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005268:Femoral Vein / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D011152:Popliteal Vein / Q000000981:diagnostic imaging; D019057:Quality-Adjusted Life Years; D014463:Ultrasonography / Q000191:economics / Q000379:methods; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000191:economics* / Q000628:therapy