Cost-effectiveness microsimulation of catheter-directed thrombolysis in submassive pulmonary embolism using a right...

Area of Science:

• Cardiology
• Health Economics
• Medical Technology

Background:

• Submassive pulmonary embolism (PE) affects 30-50% of hemodynamically stable patients.
• Right ventricular (RV) dysfunction is a key prognostic factor in PE.
• The value of reperfusion therapy for submassive PE remains uncertain.

Purpose of the Study:

• To determine the cost-effectiveness of catheter-directed thrombolysis (CDT) for submassive PE.
• To identify thresholds for high-value care with CDT in submassive PE.
• To model the impact of RV dysfunction on treatment decisions.

Main Methods:

• Individual-level, state-transition model with one million simulated patients.
• Cost-effectiveness analysis comparing CDT plus anticoagulation versus anticoagulation alone.
• Sensitivity analyses (one-way, two-way, probabilistic) to assess model uncertainty.

Main Results:

• Base case incremental cost-effectiveness ratio (ICER) was $119,326 per quality-adjusted life year.
• CDT is high-value care if it reduces absolute RV dysfunction probability by ≥3.5%.
• CDT is low-value care if absolute RV dysfunction reduction is <1.56%.

Conclusions:

• Catheter-directed thrombolysis may represent high-value care for submassive PE when it improves RV dysfunction by ≥3.5%.
• Significant uncertainty surrounds these findings, necessitating further research.
• Clarifying costs and consequences of RV dysfunction in PE could have substantial economic value ($268 million annually).