title: Cost-effectiveness of ultrasound in preventing femoral venous catheter-associated pulmonary embolism.
abstract: Femoral central venous catheter use is complicated by a high risk of deep venous thrombosis despite antithrombotic prophylaxis. Although some have recommended screening for femoral catheter-associated thrombosis to prevent pulmonary embolism (PE), this strategy's economic implications are unclear. Therefore, we used a decision model to evaluate the potential cost-effectiveness of a Doppler ultrasound-based screening strategy versus no ultrasound in averting thromboembolic complications associated with femoral catheters. The base-case analysis included a hypothetical cohort of 60-year-old medical patients treated for acute respiratory failure. The perspective was that of the health care payor, and the primary outcomes were quality-adjusted life expectancy, PE, and PE-associated deaths. The ultrasound strategy cost $8,688/quality-adjusted life-year (QALY) gained, $5,305/PE averted, and $99,286/PE death averted. The best- and worst-case scenarios, calculated in multiway sensitivity analyses by varying in-hospital mortality, deep venous thrombosis prevalence, and ultrasound accuracy, ranged from $1,170/QALY to $35,342/QALY, respectively. Probablistic analyses, in which variables with uncertain values were varied randomly within their ranges, demonstrated median costs of $12,793/QALY (interquartile range $8,176/QALY, $20,648/QALY). In summary, ultrasound screening may improve outcomes among the critically ill with femoral venous catheters at acceptable costs and could complement venous thrombosis primary prevention programs.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA. christopher.cox@duke.edu
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Cox
authors.forename: Shannon S
authors.initials: SS
authors.lastname: Carson
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Biddle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis / Q000191:economics / Q000379:methods; D003661:Decision Support Techniques; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000191:economics* / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D019057:Quality-Adjusted Life Years; D014463:Ultrasonography / Q000191:economics; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000191:economics / Q000209:etiology / Q000401:mortality