OC 60.3 - Cost-effectiveness of performing reference ultrasonography in patients with deep vein thrombosis

Tuesday, July 12, 2022

3:15 PM – 3:30 PM

Location: ExCel Center, ICC Auditorium

Presentation Format: In-Person

Presenting Author(s)

Cindy MM De Jong, MD

MD, PhD student
Department of Medicine - Thrombosis & Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
Leiden, Zuid-Holland, Netherlands

Co-Author(s)

Wv

WB van den Hout

PhD
Department of Biomedical Data Sciences - Medical Decision Making, Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
Cv

CE van Dijk

Coordinator research
National Health Care Institute
Amsterdam, Noord-Holland, Netherlands
Lv

LF van Dam

MD, PhD
Department of Thrombosis and Hemostasis, Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
GG

G Gautam

MD
Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital
Stockholm, Stockholms Lan, Sweden
Waleed Ghanima, MD

Professor
Østfold Hospital Foundation
Gralum, Ostfold, Norway
JG

Jostein Gleditsch

Consultant in Radiology
Consultant in Radiology
Fredrikstad, Ostfold, Norway
Av

A von Heijne

MD, PhD
Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital
Stockholm, Stockholms Lan, Sweden
HH

HMA Hofstee

MD, PhD
Department of Internal Medicine, Haaglanden Medical Center
The Hague, Zuid-Holland, Netherlands
MH

MMC Hovens

MD, PhD
Department of Vascular Medicine, Rijnstate Hospital
Arnhem, Gelderland, Netherlands
MH

Menno V. Huisman

MD, PhD
Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
Leiden, Zuid-Holland, Netherlands
AM

Albert T.A. Mairuhu

MD, PhD
Department of Vascular Medicine, Haga Hospital
the Hague, Zuid-Holland, Netherlands
MN

M Nijkeuter

MD, PhD
Department of Internal Medicine, University Medical Center Utrecht
Utrecht, Utrecht, Netherlands
Mv

MA van de Ree

MD, PhD
Department of Vascular Medicine, Diakonessen Hospital
Utrecht, Utrecht, Netherlands
Cv

CJ van Rooden

MD, PhD
Department of Radiology, Haga Teaching Hospital
The Hague, Zuid-Holland, Netherlands
RW

RE Westerbeek

MD
Department of Radiology, Deventer Hospital
Deventer, Overijssel, Netherlands
JW

J Westerink

MD, PhD
Department of Vascular Medicine, University Medical Center Utrecht
Utrecht, Utrecht, Netherlands
EW

E Westerlund

MD, PhD
Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital
Stockholm, Stockholms Lan, Sweden
LK

Lucia J.M. Kroft

Radiologist, MD, PhD
Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
Leiden, Zuid-Holland, Netherlands
Frederikus A. Klok, MD, PhD

MD, PhD
Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
Leiden, Zuid-Holland, Netherlands

Background: The accurate diagnosis of recurrent ipsilateral deep vein thrombosis (DVT) with compression ultrasonography (CUS) is often hindered by chronic residual abnormalities after a previous DVT. Reference CUS, an additional ultrasound performed at the time of discontinuation of anticoagulant treatment, may improve the diagnostic work-up of suspected recurrent ipsilateral DVT by providing baseline images for future comparison. Currently, it is unknown whether the application of reference CUS is cost-effective.

Aims: To evaluate the cost-effectiveness of applying reference CUS in patients with a previous DVT.

Methods: Patient-level data of the 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. The scenarios included a clinical decision rule (CDR) and D-dimer, CUS and/or magnetic resonance direct thrombus imaging (MRDTI), with and without reference CUS (Figure 1). Estimated total costs related to the associated mortality due to misdiagnosis, recurrent venous thromboembolism and bleeding during first year of treatment and follow-up were compared.

Results: All six scenarios including reference CUS had higher estimated one-year costs (€1763 to €1913; Figure 2), compared to the six scenarios without reference CUS (€1192 to €1474). Costs were higher since reference CUS results remained unused in patients without suspected recurrent DVT, which was determined to be 80% based on claims data. Estimated mortality was comparable in scenarios with reference CUS (14.8-17.9 per 10,000 patients) and without reference CUS (14.0-18.5 per 10,000 patients). None of the four potentially optimal scenarios (the ‘efficient frontier’) included reference CUS.

Conclusion(s): In this model, the one-year healthcare 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 inform policy-making regarding use of healthcare resources during follow-up after DVT and discourage the use of reference CUS in terms of cost-effectiveness.