title: The cost-effectiveness of point-of-care D-dimer tests compared with a laboratory test to rule out deep venous thrombosis in primary care.
abstract: OBJECTIVE
  Point-of-care (POC) D-dimer tests have been developed to exclude deep venous thrombosis quickly and on the spot, but are known to have lower sensitivity compared with laboratory-based tests. Their cost-effectiveness is still unknown.
  
  
  METHODS
  We updated and extended a previously published Markov model to assess the cost-effectiveness of POC D-dimer tests ('Simplify', 'Cardiac', 'Triage' and 'Nycocard') compared with a laboratory-based latex assay to diagnose deep venous thrombosis in primary care.
  
  
  RESULTS
  The 'Laboratory' strategy resulted in 6.986 quality-adjusted life years at the cost of €8354 per patient. All POC D-dimer tests resulted in health outcomes similar to the 'Laboratory' strategy. The 'Simplify' strategy maximized cost savings (-€155 [95% CI: -€246 to -€83]).
  
  
  CONCLUSIONS
  POC D-dimer tests yield similar health outcomes as laboratory-based testing procedures but can be performed more easily and at lower costs. Therefore, these tests are an alternative to laboratory-based testing and might be considered for exclusion of deep venous thrombosis in primary care.
authors.affiliation: Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO box 85500, 3508 GA, Utecht, The Netherlands.
authors.forename: Janneke M T
authors.initials: JM
authors.lastname: Hendriksen
authors.forename: Geert-Jan
authors.initials: GJ
authors.lastname: Geersing
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: van Voorthuizen
authors.forename: Ruud
authors.initials: R
authors.lastname: Oudega
authors.forename: Arina J
authors.initials: AJ
authors.lastname: Ten Cate-Hoek
authors.forename: Manuela A
authors.initials: MA
authors.lastname: Joore
authors.forename: Karel G M
authors.initials: KG
authors.lastname: Moons
authors.forename: Hendrik
authors.initials: H
authors.lastname: Koffijberg
mesh_terms: D003362:Cost-Benefit Analysis; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006801:Humans; D019095:Point-of-Care Systems / Q000191:economics*; D011320:Primary Health Care; D020246:Venous Thrombosis / Q000097:blood / Q000175:diagnosis*
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: D-dimer; cost–effectiveness; point-of-care test; primary care; venous thromboembolism