title: [Cost-effectiveness of the deep vein thrombosis diagnosis process in primary care].
abstract: OBJECTIVE
  To analyse the cost effectiveness of the application of diagnostic algorithms in patients with a first episode of suspected deep vein thrombosis (DVT) in Primary Care compared with systematic referral to specialised centres.
  
  
  METHODS
  Observational, cross-sectional, analytical study.
  
  
  METHODS
  Patients from hospital emergency rooms referred from Primary Care to complete clinical evaluation and diagnosis.
  
  
  METHODS
  A total of 138 patients with symptoms of a first episode of DVT were recruited; 22 were excluded (no Primary Care report, symptoms for more than 30 days, anticoagulant treatment, and previous DVT). Of the 116 patients finally included, 61% women and the mean age was 71 years.
  
  
  METHODS
  Variables from the Wells and Oudega clinical probability scales, D-dimer (portable and hospital), Doppler ultrasound, and direct costs generated by the three algorithms analysed: all patients were referred systematically, referral according to Wells and Oudega scale.
  
  
  RESULTS
  DVT was confirmed in 18.9%. The two clinical probability scales showed a sensitivity of 100% (95% CI: 85.1 to 100) and a specificity of about 40%. With the application of the scales, one third of all referrals to hospital emergency rooms could have been avoided (P<.001). The diagnostic cost could have been reduced by € 8,620 according to Oudega and € 9,741 according to Wells, per 100 patients visited.
  
  
  CONCLUSIONS
  The application of diagnostic algorithms when a DVT is suspected could lead to better diagnostic management by physicians, and a more cost effective process.
authors: Centro Atención Primaria A.B.S. 6B Vila de Gracia, Institut Català de la Salut, Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España. Electronic address: emfuentes.bcn.ics@gencat.cat.
authors: Eva
authors: E
authors: Fuentes Camps
authors: Unidad de Soporte a la Investigación del Ámbito Atención Primaria de Barcelona, Institut Català de la Salut-IDIAP-Jordi Gol, Barcelona, España.
authors: José
authors: J
authors: Luis del Val García
authors: Servicio de Angiología, Cirugía Vascular y Endovascular. Hospital de la Santa Creu i Sant Pau, Barcelona, España; Institut de Investigació Biomèdica (IIB Sant Pau), Barcelona, España.
authors: Sergi
authors: S
authors: Bellmunt Montoya
authors: Servicio de Angiología, Cirugía Vascular y Endovascular. Hospital de la Santa Creu i Sant Pau, Barcelona, España; Institut de Investigació Biomèdica (IIB Sant Pau), Barcelona, España.
authors: Sara
authors: S
authors: Hmimina Hmimina
authors: Servicio de Angiología, Cirugía Vascular y Endovascular. Hospital de la Santa Creu i Sant Pau, Barcelona, España; Institut de Investigació Biomèdica (IIB Sant Pau), Barcelona, España.
authors: Efren
authors: E
authors: Gómez Jabalera
authors: Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España; Unidad de Soporte a la Investigación del Ámbito Atención Primaria de Barcelona, Institut Català de la Salut-IDIAP-Jordi Gol, Barcelona, España.
authors: Miguel Ángel
authors: MÁ
authors: Muñoz Pérez
mesh_terms: D000368:Aged; D000465:Algorithms; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011320:Primary Health Care; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000191:economics*
keywords: Análisis coste efectividad; Atención primaria; Cost effectiveness analysis; Deep vein thrombosis; Diagnosis; Diagnóstico; Primary care; Trombosis venosa profunda