Cost-effectiveness of the deep vein thrombosis diagnosis process in primary care

Eva Fuentes Camps, José Luis Del Val García, Sergi Bellmunt Montoya, Sara Hmimina Hmimina, Efren Gómez Jabalera, Miguel Ángel Muñoz Pérez

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    Abstract

    © 2015 Elsevier España, S.L.U. Objective To analyse the cost effectiveness of the application of diagnostic algorithms in patients with a first episode of suspected deep vein thrombosis (DVT) in Primary Care compared with systematic referral to specialised centres. Design Observational, cross-sectional, analytical study. Location Patients from hospital emergency rooms referred from Primary Care to complete clinical evaluation and diagnosis. Participants A total of 138 patients with symptoms of a first episode of DVT were recruited; 22 were excluded (no Primary Care report, symptoms for more than 30 days, anticoagulant treatment, and previous DVT). Of the 116 patients finally included, 61% women and the mean age was 71 years. Main measurements Variables from the Wells and Oudega clinical probability scales, D-dimer (portable and hospital), Doppler ultrasound, and direct costs generated by the three algorithms analysed: all patients were referred systematically, referral according to Wells and Oudega scale. Results DVT was confirmed in 18.9%. The two clinical probability scales showed a sensitivity of 100% (95% CI: 85.1 to 100) and a specificity of about 40%. With the application of the scales, one third of all referrals to hospital emergency rooms could have been avoided (P<.001). The diagnostic cost could have been reduced by € 8,620 according to Oudega and € 9,741 according to Wells, per 100 patients visited. Conclusion The application of diagnostic algorithms when a DVT is suspected could lead to better diagnostic management by physicians, and a more cost effective process.
    Original languageEnglish
    Pages (from-to)251-257
    JournalAtencion Primaria
    Volume48
    Issue number4
    DOIs
    Publication statusPublished - 1 Apr 2016

    Keywords

    • Cost effectivenessanalysis
    • Deep vein thrombosis
    • Diagnosis
    • Primary care

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