ABSTRACT
Improvements in the methods of clinical trials combined with the use of objective
tests to detect venous thrombosis have enhanced the clinician's ability to diagnose
pulmonary embolism and venous thrombosis (venous thromboembolism).
The authors updated a previous cost-effectiveness analysis of the commonly recommended
strategies for pulmonary embolism diagnosis and management to reflect current clinical
practice. Two criteria of effectiveness were used: correct identification of venous
thromboembolism and correct identification of venous thromboembolism and correct identification
of patients for whom treatment was unnecessary. The cost of each diagnostic alternative
was defined as the direct cost of administering the diagnostic tests plus the treatment
costs associated with a positive test result. A strategy based on the combined use
of ventilation-perfusion lung scanning, serial ultrasonography, cardiorespiratory
evaluation, and pulmonary angiography was the most cost-effective. This strategy also
necessitated pulmonary angiography in the fewest number of patients. The safety of
this strategy relates to two important biologic concepts: 1) local extension of submassive
pulmonary embolism in the lung is not an important cause of morbidity or mortality
in patients with adequate cardiorespiratory reserve, and 2) in most patients, proximal
vein thrombi of the lower extremities are the source of recurrent pulmonary embolism.
KEYWORD
Pulmonary embolism - diagnosis - cost-effectiveness - venous thromboembolism
