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Thromb Haemost 2024; 124(06): 557-567
DOI: 10.1055/a-2213-9230
Stroke, Systemic or Venous Thromboembolism

Cost-Effectiveness of Performing Reference Ultrasonography in Patients with Deep Vein Thrombosis

Cindy M. M. de Jong
1   Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
,
Wilbert B. van den Hout
2   Department of Biomedical Data Sciences - Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
,
Christel E. van Dijk
3   National Health Care Institute, The Netherlands
,
Noor Heim
3   National Health Care Institute, The Netherlands
,
Lisette F. van Dam
1   Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
4   Department of Emergency Medicine, Haga Teaching Hospital, The Hague, The Netherlands
,
Charlotte E. A. Dronkers
1   Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
,
Gargi Gautam
5   Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
,
Waleed Ghanima
6   Department of Internal Medicine, Østfold Hospital Trust, Gralum, Norway
7   Department of Haematology, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
,
Jostein Gleditsch
8   Department of Radiology, Østfold Hospital Trust, Gralum, Norway
,
Anders von Heijne
5   Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
,
Herman M. A. Hofstee
9   Department of Internal Medicine, Haaglanden Medical Center, The Hague, The Netherlands
,
Marcel M. C. Hovens
10   Department of Vascular Medicine, Rijnstate Hospital, Arnhem, The Netherlands
,
Menno V. Huisman
1   Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
,
Stan Kolman
11   Department of Vascular Medicine, Diakonessen Hospital, Utrecht, The Netherlands
,
Albert T. A. Mairuhu
12   Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
,
Thijs E. van Mens
1   Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
,
Mathilde Nijkeuter
13   Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
,
Marcel A. van de Ree
11   Department of Vascular Medicine, Diakonessen Hospital, Utrecht, The Netherlands
,
Cornelis J. van Rooden
14   Department of Radiology, Haga Teaching Hospital, The Hague, The Netherlands
,
Robin E. Westerbeek
15   Department of Radiology, Deventer Hospital, Deventer, The Netherlands
,
Jan Westerink
16   Department of Internal Medicine, Isala Hospital, Zwolle, The Netherlands
,
Eli Westerlund
5   Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
,
Lucia J. M. Kroft
17   Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
,
Frederikus A. Klok 
1   Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
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Abstract

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.

Keywords

cost-effectiveness analysis - deep vein thrombosis - diagnostic imaging - recurrence - ultrasonography

Supplementary Material



Publication History

Received: 19 September 2023

Accepted: 17 November 2023

Accepted Manuscript online:
20 November 2023

Article published online:
27 December 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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