Cost effectiveness of the addition of a comprehensive CT scan to the abdomen and pelvis for the detection of cancer after unprovoked venous thromboembolism.
OBJECTIVE
Unprovoked venous thromboembolism (VTE) can be the first manifestation of cancer. It is unclear if extensive screening for occult cancer including a comprehensive computed tomography (CT) scan of the abdomen/pelvis is cost-effective in this patient population.


OBJECTIVE
To assess the health care related costs, number of missed cancer cases and health related utility values of a limited screening strategy with and without the addition of a comprehensive CT scan of the abdomen/pelvis and to identify to what extent testing should be done in these circumstances to allow early detection of occult cancers.


METHODS
Cost effectiveness analysis using data that was collected alongside the SOME randomized controlled trial which compared an extensive occult cancer screening including a CT of the abdomen/pelvis to a more limited screening strategy in patients with a first unprovoked VTE, was used for the current analyses.


METHODS
Analyses were conducted with a one-year time horizon from a Canadian health care perspective. Primary analysis was based on complete cases, with sensitivity analysis using appropriate multiple imputation methods to account for missing data.


RESULTS
Data from a total of 854 patients with a first unprovoked VTE were included in these analyses. The addition of a comprehensive CT scan was associated with higher costs ($551 CDN) with no improvement in utility values or number of missed cancers. Results were consistent when adopting multiple imputation methods.


CONCLUSIONS
The addition of a comprehensive CT scan of the abdomen/pelvis for the screening of occult cancer in patients with unprovoked VTE is not cost effective, as it is both more costly and not more effective in detecting occult cancer.
Brunel University, Uxbridge, Middlesex, United Kingdom, Kingston Ln, Uxbridge UB8 3PH, United Kingdom. Electronic address: Kathryn.Coyle@brunel.ac.uk.
Kathryn
K
Coyle
University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada; Ottawa Hospital Research Institute, Ottawa Hospital, 725 Parkdale Avenue, Ottawa, ON K1Y 4E9, Canada. Electronic address: mcarrier@toh.ca.
Marc
M
Carrier
Department of Medicine, University of Western Ontario, 1151 Richmond St, London, ON N6A 3K7, Canada; Department of Epidemiology and Biostatistics, University of Western Ontario, 1151 Richmond St, London, ON N6A 3K7, Canada. Electronic address: Alejandro.LazoLangner@lhsc.on.ca.
Alejandro
A
Lazo-Langner
Department of Hematology, Queen Elizabeth II Health Sciences Centre, 1V8, 5805 South St, Halifax, NS B3H, Canada; Department of Medicine, Dalhousie University, 6299 South St, Halifax, NS B3H 4R2, Canada. Electronic address: Sudeep.Shivakumar@nshealth.ca.
Sudeep
S
Shivakumar
Department of Medicine, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB R3T 2N2, Canada; Department of Hematology and Medical Oncology, Cancercare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada. Electronic address: rzarychanski@cancercare.mb.ca.
Ryan
R
Zarychanski
Department of Medicine, Sir Mortimer B. Davis Jewish General Hospital, 3755 Côte-Ste-Catherine Road, Montréal, QC H3T 1E2, Canada; Center for Clinical Epidemiology, Lady Davis Institute, 3755 Chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1E2, Canada. Electronic address: vicky.tagalakis@mcgill.ca.
Vicky
V
Tagalakis
Department of Medicine, McGill University, 845 Rue Sherbrooke O, Montréal, QC H3A 0G4, Canada; Division of Hematology, Montreal General Hospital, 1650 Avenue Cedar, Montréal, QC H3G, Canada; St. Mary's Hospital, 3830 Lacombe Avenue, Montréal, QC H3T 1M5, Canada. Electronic address: susan.solymoss@mcgill.ca.
Susan
S
Solymoss
Department of Medicine, Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC H3T 1J4, Canada; Sacre Coeur Hospital, 5400 Boul Gouin O, Montréal, QC H4J 1C5, Canada. Electronic address: nathalie.routhier@gmail.com.
Nathalie
N
Routhier
St. Joseph's Healthcare Hamilton, 50 Charlton Ave. E., Hamilton, Ontario L8N 4A6, Canada; Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada. Electronic address: jdouket@mcmaster.ca.
James
J
Douketis
Brunel University, Uxbridge, Middlesex, United Kingdom, Kingston Ln, Uxbridge UB8 3PH, United Kingdom; University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada; Ottawa Hospital Research Institute, Ottawa Hospital, 725 Parkdale Avenue, Ottawa, ON K1Y 4E9, Canada. Electronic address: dcoyle@ohri.ca.
Douglas
D
Coyle
D000005:Abdomen / Q000000981:diagnostic imaging; D002170:Canada / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000191:economics / Q000453:epidemiology; D010388:Pelvis / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000191:economics*; D035501:Uncertainty; D054556:Venous Thromboembolism / Q000150:complications*
Cancer screening tests; Oncology; Thromboembolism; Tomography, X-ray computed