Related Experiment Video
Updated: Jul 10, 2025
Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
Published on: February 10, 2023
Cost-Effectiveness of Performing Reference Ultrasonography in Patients with Deep Vein Thrombosis
Cindy M M de Jong1, Wilbert B van den Hout2, Christel E van Dijk3
1Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.
Insights
Routine reference compression ultrasonography (CUS) for suspected recurrent deep vein thrombosis (DVT) increases healthcare costs without improving patient survival. This diagnostic strategy is not cost-effective for managing DVT recurrence.
Area of Science:
- Vascular Medicine
- Diagnostic Imaging
- Health Economics
Background:
- Diagnosing recurrent deep vein thrombosis (DVT) can be challenging due to residual obstruction from prior DVTs.
- Reference compression ultrasonography (CUS) provides baseline images for comparison but its utility is debated.
Purpose of the Study:
- To evaluate the cost-effectiveness of routinely performing reference CUS in patients with suspected recurrent ipsilateral DVT.
Main Methods:
- A decision analytic model compared 12 diagnostic management scenarios for suspected recurrent DVT.
- Patient data from a prospective study and claims data were utilized.
- Costs and mortality were compared for the first year of follow-up.
Main Results:
- Scenarios with reference CUS incurred higher 1-year costs (€1,763-€1,913) than those without (€1,192-€1,474).
- Estimated mortality rates were similar across all scenarios.
- Reference CUS results were often unused, as 20% of patients presented with suspected recurrence.
Conclusions:
- Routine reference CUS for suspected recurrent DVT is more costly and offers no mortality benefit.
- Findings suggest against the routine use of reference CUS from a cost-effectiveness standpoint.
- Results can guide healthcare resource allocation for DVT follow-up.
Background:
The diagnosis of recurrent ipsilateral deep vein thrombosis (DVT) with compression ultrasonography (CUS) may be hindered by residual intravascular obstruction after previous DVT. A reference CUS, an additional ultrasound performed at anticoagulant discontinuation, may improve the diagnostic work-up of suspected recurrent ipsilateral DVT by providing baseline images for future comparison.
Objectives:
To evaluate the cost-effectiveness of routinely performing reference CUS in DVT patients.
Methods:
Patient-level data (n = 96) from a prospective management study (Theia study; NCT02262052) and claims data were used in a decision analytic model to compare 12 scenarios for diagnostic management of suspected recurrent ipsilateral DVT. Estimated health care costs and mortality due to misdiagnosis, recurrent venous thromboembolism, and bleeding during the first year of follow-up after presentation with suspected recurrence were compared.
Results:
All six scenarios including reference CUS had higher estimated 1-year costs (€1,763-€1,913) than the six without reference CUS (€1,192-€1,474). Costs were higher because reference CUS results often remained unused, as 20% of patients (according to claims data) would return with suspected recurrent DVT. Estimated mortality was comparable in scenarios with (14.8-17.9 per 10,000 patients) and without reference CUS (14.0-18.5 per 10,000). None of the four potentially most desirable scenarios included reference CUS.
Conclusion:
One-year health care costs of diagnostic strategies for suspected recurrent ipsilateral DVT including reference CUS are higher compared to strategies without reference CUS, without mortality benefit. These results can inform policy-makers regarding use of health care resources during follow-up after DVT. From a cost-effectiveness perspective, the findings do not support the routine application of reference CUS.
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