| Cost-effectiveness analysis of diagnostic strategies for suspected pulmonary embolism including helical computed tomography. | |
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MedLine Citation:
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PMID: 12502474 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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We performed a formal decision analysis to evaluate the cost-effectiveness of various strategies for pulmonary embolism, including helical computed tomography (CT), and determined the most cost-effective schemes for each clinical probability of pulmonary embolism. Other tests included D-dimer (DD), lower limb venous ultrasound (US), ventilation-perfusion (V/Q) scan, and angiography. Outcome measures were 3-month survival and costs per patient managed. Baseline sensitivity of CT was 70%, corresponding to the performance of single-detector CT, and that figure was raised in sensitivity analysis to account for the expected higher sensitivity of newer multidetector CT scanners. All strategies were compared with a reference strategy, namely the V/Q scan in all patients followed when nondiagnostic by an angiogram. For low clinical probability patients, the most cost-effective strategy was DD, US, and V/Q scan, patients with a nondiagnostic V/Q scan being left untreated. Replacing V/Q scan by CT was also cost-effective. For intermediate and high clinical probability patients, a fourth test must be added, either CT or angiography in patients with nondiagnostic V/Q scan, or angiography in patients with a negative helical CT. When using sensitivity figures above 85% (in the multidetector range), DD, US, and CT became the most cost-effective strategy for all clinical probability categories. Helical CT as a single test was not cost-effective. In summary, including helical CT in diagnostic strategies for pulmonary embolism is cost-effective provided that it is combined with DD and US. In contrast, helical CT as a single test is not cost-effective. |
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Authors:
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Arnaud Perrier; Mathieu R Nendaz; François P Sarasin; Nigel Howarth; Henri Bounameaux |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: American journal of respiratory and critical care medicine Volume: 167 ISSN: 1073-449X ISO Abbreviation: Am. J. Respir. Crit. Care Med. Publication Date: 2003 Jan |
Date Detail:
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Created Date: 2002-12-27 Completed Date: 2003-02-13 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 9421642 Medline TA: Am J Respir Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 39-44 Citation Subset: AIM; IM |
Affiliation:
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Medical Clinic 1, Geneva University Hospital, Geneva, Switzerland. arnaud.perrier@medecine.unige.ch |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Angiography Cost-Benefit Analysis Decision Trees Fibrin Fibrinogen Degradation Products / analysis Humans Leg / blood supply Pulmonary Embolism / diagnosis* Sensitivity and Specificity Tomography, Spiral Computed / economics* Ultrasonography Ventilation-Perfusion Ratio |
| Chemical | |
Reg. No./Substance:
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0/Fibrin Fibrinogen Degradation Products; 0/fibrin fragment D |
| Comments/Corrections | |
Comment In:
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Am J Respir Crit Care Med. 2004 Jan 1;169(1):129; author reply 129-30
[PMID:
14695108
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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