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DeepDyve Pubget Overpricing |
lüll How should we diagnose suspected deep-vein thrombosis?Goodacre S; Stevenson M; Wailoo A; Sampson F; Sutton AJ; Thomas SQJM 2006[Jun]; 99 (6): 377-88BACKGROUND: Many different approaches are used to diagnose suspected deep-vein thrombosis (DVT), but there has been little formal comparison of strategies. AIM: To identify the most cost-effective strategy for the UK National Health Service (NHS). DESIGN: Systematic review, meta-analysis and cost-effectiveness analysis. METHODS: We identified 18 strategies and estimated the diagnostic performance of constituent tests by systematic review and meta-analysis. Outcomes of testing and treatment were estimated from published data or by an expert panel. Costs were estimated from NHS reference costs and published data. We built a decision-analysis model to estimate, for each strategy, the overall accuracy, costs, and outcomes (valued as quality-adjusted life-years, QALYs), compared to a 'no testing, no treatment' alternative. Probabilistic analysis estimated the net benefit of each strategy at varying thresholds for willingness to pay for health gain. RESULTS: At the thresholds for willingness to pay recommended by the National Institute for Clinical Excellence (20,000 pounds sterling-30,000 pounds sterling per QALY), the optimal strategy was to discharge patients with a low or intermediate Wells score and negative D-dimer, limiting ultrasound to those with a high score or positive D-dimer. Strategies using radiological testing for all patients were only cost-effective at 40,000 pound sterling per QALY or more. DISCUSSION: The optimal strategy for DVT diagnosis is to use ultrasound selectively in patients with a high clinical risk or positive D-dimer. Radiological testing for all patients does not appear to be a cost-effective use of health service resources.|Cost-Benefit Analysis[MESH]|Decision Support Techniques[MESH]|Diagnostic Techniques, Cardiovascular/economics[MESH]|Humans[MESH]|Quality-Adjusted Life Years[MESH]|State Medicine/economics[MESH]|United Kingdom[MESH]|Venous Thrombosis/*diagnosis[MESH] |