title: Cost-effectiveness of risk assessment and tailored treatment for peripheral arterial disease patients.
abstract: OBJECTIVE
  The objective of this study was to explore the cost-effectiveness of D-dimer biomarker and the societal value (headroom) of a hypothetical perfect biomarker for risk assessment and subsequent treatment stratification of prophylactic treatment for peripheral arterial disease (PAD).
  
  
  METHODS
  Decision analytic modeling.
  
  
  RESULTS
  Use of the D-dimer biomarker to prescribe oral anticoagulants in the high-risk subset of patients is a cost-effective healthcare intervention. The headroom (societal willingness to pay multiplied by incremental quality-adjusted life years) available for the hypothetical perfect biomarker amounted to €83,877.
  
  
  CONCLUSIONS
  D-dimer-based PAD risk assessment and treatment tailoring is cost effective. Identification of high-risk PAD patients and prescription of oral anticoagulants could potentially save substantial costs and improve chances of survival for high-risk PAD patients. However, further research of risk stratifying biomarkers test accuracy is needed to support and strengthen the results of this modeling study.
authors.affiliation: Department of Clinical Epidemiology & Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
authors.forename: Anil
authors.initials: A
authors.lastname: Vaidya
authors.forename: Manuela A
authors.initials: MA
authors.lastname: Joore
authors.forename: Arina J
authors.initials: AJ
authors.lastname: ten Cate-Hoek
authors.forename: Hugo
authors.initials: H
authors.lastname: ten Cate
authors.forename: Johan L
authors.initials: JL
authors.lastname: Severens
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000639:trends*; D006801:Humans; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment
chemical_list: D000925:Anticoagulants; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: D-dimer; cost–effectiveness analysis; decision modeling; peripheral arterial disease; risk assessment