Document Detail


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...