title: Cost-effective diagnostic strategies in patients with a high, intermediate, or low clinical probability of pulmonary embolism.
abstract: Rapid quantitative D-dimer assays (DD), lower extremity venous duplex ultrasonography (US), and multislice computed tomographic (CT) angiography have been shown to have adequate sensitivities and specificities for diagnostic purpose. The purpose of this study was to evaluate cost-effectiveness of diagnostic strategies for pulmonary embolism (PE) in patients with a high, intermediate, or low clinical probability of PE. A formal cost-effectiveness analysis for the diagnosis of PE was performed. The main outcome measure for effectiveness was 3-month expected survival. The strategy of DD followed by CT was cost-effective and had the lowest cost per life saved for all patients suspected with PE. The conventional strategy including ventilation and perfusion lung scanning followed by pulmonary angiography (PA) or CT was not cost-effective. The leg US after CT was not also cost-effective. In clinical practice, the individual patient's condition should be considered when choosing appropriate diagnostic tests.
authors.affiliation: College of Health Sciences, University of California-Irvine, Irvine, CA 92697, USA. jungahl@uci.edu
authors.forename: Jung-Ah
authors.initials: JA
authors.lastname: Lee
authors.forename: Brenda K
authors.initials: BK
authors.lastname: Zierler
authors.forename: Chuan-Fen
authors.initials: CF
authors.lastname: Liu
authors.forename: Michael K
authors.initials: MK
authors.lastname: Chapko
mesh_terms: D000925:Anticoagulants / Q000191:economics / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001774:Blood Chemical Analysis / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D016527:Drug Costs; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D017048:Health Care Costs; D006801:Humans; D018803:Models, Economic; D018579:Patient Selection; D055420:Perfusion Imaging / Q000191:economics; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics / Q000209:etiology / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000191:economics*; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex / Q000191:economics*
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D