Pulmonary embolism and lung scanning: cost-effectiveness and benefit:risk

Area of Science:

• Medical Imaging
• Health Economics
• Pulmonary Medicine

Background:

• Pulmonary embolism (PE) diagnosis and management present significant clinical and economic challenges.
• Optimizing diagnostic strategies is crucial for patient outcomes and healthcare resource allocation.

Purpose of the Study:

• To evaluate the cost-effectiveness of pulmonary imaging (lung scan) in managing patients with suspected pulmonary embolism (PE).
• To assess the impact of lung scans on anticoagulant therapy (ACT) decisions and patient survival.

Main Methods:

• Analysis of management data for 2,023 patients undergoing pulmonary imaging.
• Determination of pre- and post-scan probabilities of PE by referring physicians.
• Calculation of incremental scanning costs and associated benefits (lives saved, reduced hospitalization/ACT costs).

Main Results:

• Lung scans appropriately changed ACT in 20% of patients and confirmed it in 67%.
• Scanning costs per patient varied significantly with prior PE probability ($124 at 0.01-9.99% vs. $38 at 10-25%).
• Hospitalization and ACT costs decreased when prior PE probability was >25%.
• The greatest benefit was observed in the 25-74.99% prior probability group, with 1.5% lives saved at $117 per life saved.
• The benefit-to-risk ratio (lives saved vs. radiation-induced deaths) was approximately 6,000:1.

Conclusions:

• Pulmonary imaging is a cost-effective tool for managing suspected pulmonary embolism, particularly in patients with intermediate to high pre-scan probabilities.
• Lung scans significantly influence clinical management decisions, leading to improved patient survival and efficient resource utilization.
• The study demonstrates a favorable benefit-risk profile for pulmonary imaging in the context of PE diagnosis.