TY - JOUR
T1 - Cost-effectiveness of the deep vein thrombosis diagnosis process in primary care
AU - Fuentes Camps, Eva
AU - Luis Del Val García, José
AU - Bellmunt Montoya, Sergi
AU - Hmimina Hmimina, Sara
AU - Gómez Jabalera, Efren
AU - Muñoz Pérez, Miguel Ángel
PY - 2016/4/1
Y1 - 2016/4/1
N2 - © 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.
AB - © 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.
KW - Cost effectivenessanalysis
KW - Deep vein thrombosis
KW - Diagnosis
KW - Primary care
U2 - 10.1016/j.aprim.2015.05.006
DO - 10.1016/j.aprim.2015.05.006
M3 - Article
VL - 48
SP - 251
EP - 257
JO - Atencion Primaria
JF - Atencion Primaria
SN - 0212-6567
IS - 4
ER -