What question did this study set out to answer?

To evaluate the clinical outcomes and cost-effectiveness of nine different invasive and noninvasive diagnostic strategies for managing suspected pulmonary embolism.

April 26, 1993Archives of Internal Medicine

Cost-effectiveness Analysis of Various Strategies in the Diagnostic Management of Pulmonary Embolism

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Why the study?

What is the most cost-effective diagnostic management strategy for suspected pulmonary embolism?

Population

Patients with suspected pulmonary embolism (modeled based on published data)

Comparison

Various diagnostic management strategies vs Alternative diagnostic strategies

Design

Other

Authors

MOMatthijs OudkerkCardiac Imaging

Discussion

Member takes

Implication

May support cost-effective angiography strategies for suspected PE; leaves open validation against contemporary CT-based approaches.

Key Points

To evaluate the clinical outcomes and cost-effectiveness of nine different invasive and noninvasive diagnostic strategies for managing suspected pulmonary embolism.
Constructed a decision analytic model based on assumptions extracted from published medical literature.
Calculated diagnostic and therapeutic costs, mortality, morbidity, and appropriateness of anticoagulant therapy indications across nine diagnostic strategies.
Determined cost-effectiveness utilizing incremental costs per additional life saved.
Treating all suspected patients or all with abnormal perfusion scans achieved the lowest mortality and morbidity, but produced the highest costs due to inappropriate treatment in 55% to 70% of patients.
Pulmonary angiography strategies—with or without initial perfusion-ventilation scintigraphy and leg ultrasonography—achieved similarly low mortality and morbidity, approximately 40% cost savings, and under 5% inappropriate treatment.
Strategies relying exclusively on perfusion-ventilation scintigraphy with or without ultrasonography led to unacceptably high mortality rates.

Structured PICO

What is the most cost-effective diagnostic management strategy for suspected pulmonary embolism?

Population

Patients with suspected pulmonary embolism (modeled based on published data)

Intervention

Various diagnostic management strategies (including pulmonary angiography, perfusion-ventilation lung scintigraphy, and ultrasonography)

Comparator

Alternative diagnostic strategies

Outcome

Cost-effectiveness (incremental costs per additional life saved), mortality, morbidity, adequacy of anticoagulant therapy, and associated costs

A diagnostic strategy for pulmonary embolism that includes pulmonary angiography, potentially preceded by scintigraphy and ultrasonography, is cost-effective and minimizes inappropriate treatment.

Cite This Study

Matthijs Oudkerk (1993) studied this question.

synapsesocial.com/papers/6a18e0d7c9d74cf65281fc2d https://doi.org/10.1001/archinte.1993.00410080017003

Topics

Pulmonary embolism

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Cost-effectiveness Analysis of Various Strategies in the Diagnostic Management of Pulmonary Embolism

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Cost-effectiveness Analysis of Various Strategies in the Diagnostic Management of Pulmonary Embolism

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider