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Cost effectiveness of clinical diagnosis, venography, and noninvasive testing in patients with symptomatic deep-vein
Insights
Clinical diagnosis of deep-vein thrombosis is cost ineffective. Objective methods like venography and impedance plethysmography with leg scanning offer more cost-effective diagnostic strategies for venous thromboembolism.
Area of Science:
- Medical Diagnostics
- Health Economics
- Vascular Medicine
Background:
- Historically, clinical diagnosis guided deep-vein thrombosis (DVT) treatment.
- Studies revealed clinical diagnosis lacks specificity for venous thrombosis.
- Objective diagnostic methods are now common, but their cost-effectiveness requires study.
Purpose of the Study:
- To conduct a cost-effectiveness analysis of diagnostic strategies for suspected venous thrombosis.
- To compare clinical diagnosis, venography, and impedance plethysmography plus leg scanning.
- To rank these methods by cost and effectiveness.
Main Methods:
- Cost-effectiveness analysis of 516 patients with suspected venous thrombosis.
- Evaluation of clinical diagnosis, venography, and impedance plethysmography with leg scanning.
- Ranking diagnostic approaches based on cost and effectiveness.
Main Results:
- Clinical diagnosis was found to be cost ineffective.
- Venography demonstrated cost-effectiveness, particularly in outpatient settings.
- Impedance plethysmography plus leg scanning is a viable, less invasive alternative to outpatient venography.
Conclusions:
- Outpatient diagnostic procedures should be prioritized to manage costs.
- Venography and impedance plethysmography with leg scanning are superior to clinical diagnosis for venous thrombosis.
- Optimizing diagnostic pathways can improve cost-effectiveness in venous thromboembolism management.
Abstract:
Until the past decade, physicians were content to base therapeutic decisions on the clinical diagnosis of deep-vein thrombosis. Subsequently, numerous studies demonstrated that clinical diagnosis of this condition is nonspecific. Although many now use objective methods to diagnose venous thrombosis, their relative cost and effectiveness have not been adequately studied. We performed a cost-effectiveness analysis of 516 patients with clinically suspected venous thrombosis who were evaluated by clinical diagnosis, venography, and the less invasive combination of impedance plethysmography and leg scanning. We used this analysis to rank these alternative approaches in terms of both cost and effectiveness. The results indicate that clinical diagnosis is cost ineffective. Venography is cost effective--more so when applied as an outpatient investigation. Impedance plethysmography plus leg scanning is a practical, less invasive alternative to outpatient venography. The cost of inpatient diagnosis is likely to remain the major cost; thus, emphasis should be placed on outpatient diagnostic procedures.