| Cost-effectiveness of ruling out deep venous thrombosis in primary care versus care as usual. | |
| | |
MedLine Citation:
|
PMID: 19793189 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: Referral for ultrasound testing in all patients suspected of DVT is inefficient, because 80-90% have no DVT. Objective: To assess the incremental cost-effectiveness of a diagnostic strategy to select patients at first presentation in primary care based on a point of care D-dimer test combined with a clinical decision rule (AMUSE strategy), compared with hospital-based strategies. PATIENTS/METHODS: A Markov-type cost-effectiveness model with a societal perspective and a 5-year time horizon was used to compare the AMUSE strategy with hospital-based strategies. Data were derived from the AMUSE study (2005-2007), the literature, and a direct survey of costs (2005-2007). RESULTS OF BASE-CASE ANALYSIS: Adherence to the AMUSE strategy on average results in savings of euro138 ($185) per patient at the expense of a very small health loss (0.002 QALYs) compared with the best hospital strategy. The iCER is euro55 753($74 848). The cost-effectiveness acceptability curves show that the AMUSE strategy has the highest probability of being cost-effective. RESULTS OF SENSITIVITY ANALYSIS: Results are sensitive to decreases in sensitivity of the diagnostic strategy, but are not sensitive to increase in age (range 30-80), the costs for health states, and events. CONCLUSION: A diagnostic management strategy based on a clinical decision rule and a point of care D-dimer assay to exclude DVT in primary care is not only safe, but also cost-effective as compared with hospital-based strategies. |
| | |
Authors:
|
A J Ten Cate-Hoek; D B Toll; H R B?ller; A W Hoes; K G M Moons; R Oudega; H E J H Stoffers; E F van der Velde; H C P M van Weert; M H Prins; M A Joore |
Related Documents
:
|
10166279 - How much does excess inpatient capacity really cost? 15714339 - A modified three-stage data envelopment analysis. the netherlands. 16541479 - Evidence-based medicine is affordable: the cost-effectiveness of current compared with ... 18700509 - Economic consequences of falls and fractures among older people. 15005129 - Managing patient care cost in minnesota medical group practices. 12971009 - Open referral system improves access, but at a cost. 22427139 - I could never quite get it together: lessons for end-of -life care in harold pinter's t... 10304099 - Pregnant women eligible under medicaid expansion of maternity services. implications fo... 8228139 - Hospice and medicare benefits: overview, issues, and implications. |
Publication Detail:
|
Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2009-09-28 |
Journal Detail:
|
Title: Journal of thrombosis and haemostasis : JTH Volume: 7 ISSN: 1538-7836 ISO Abbreviation: J. Thromb. Haemost. Publication Date: 2009 Dec |
Date Detail:
|
Created Date: 2009-12-18 Completed Date: 2010-03-02 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 101170508 Medline TA: J Thromb Haemost Country: England |
Other Details:
|
Languages: eng Pagination: 2042-9 Citation Subset: IM |
Affiliation:
|
Department of Clinical Epidemiology, Maastricht University Medical Center, Maastricht, The Netherlands. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Aged Aged, 80 and over Algorithms Cost-Benefit Analysis Data Collection Decision Support Techniques* Fibrin Fibrinogen Degradation Products / analysis Humans Middle Aged Point-of-Care Systems Probability Venous Thrombosis / diagnosis*, economics*, ultrasonography |
| Chemical | |
Reg. No./Substance:
|
0/Fibrin Fibrinogen Degradation Products; 0/fibrin fragment D |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Comparison of the clinical history of symptomatic isolated distal deep-vein thrombosis versus proxim...
Next Document: Early-onset and persisting thrombocytopenia in post-cardiac surgery patients is rarely due to hepari...