PCV29 THE COST-EFFECTIVENESS OF DIAGNOSTIC STRATEGIES WITH ANGIOGRAPHY AND/OR DUPLEX SCANNING FOR AORTOILIAC AND FEMOROPOPLITEAL ARTERIAL DISEASE

OBJECTIVE: To assess the cost effectiveness of azithromycin versus doxycycline therapy for cervicalChlamydia trachomatisinfections in Canada.DESIGN: A predictive decision analytic model using previously published clinical and economic evaluations, expert opinion and costs of medical care in Canada.POPULATION: A hypothetical cohort of 5000 women followed over 10 years.INTERVENTIONS: Two diagnostic strategies were compared, laboratory confirmed diagnosis (LCD) and presumptive diagnosis (PD) ofC trachomatisinfection. Under each strategy, two treatment alternatives were analyzed, a single 1 g dose of azithromycin and a seven-day course of doxycycline as 100 mg twice daily.RESULTS: Despite a fourfold higher acquisition cost, under base case conditions, for both diagnostic strategies, the azithromycin treatment alternative was more cost effective than the doxycycline alternative. For the LCD model, the cost per cure for patients receiving azithromycin was $184.76 compared with $240.59 for patients receiving doxycycline, resulting in an incremental cost of $55.83. For the PD model, the cost per cure for patients treated with azithromycin was $51.48 compared with $51.82, resulting in an incremental cost of $0.34. For the hypothetical cohort of 5000 women, the use of azithromycin translates into a projected annual cost savings of $279,150 and $1,700 for the LCD and PD models, respectively. In one-way sensitivity analyses for the LCD model, no clinically plausible changes in the base case estimates changed the results of the cost effectiveness outcome. In the PD model, clinically plausible changes in the probabilities of doxycycline cure, pelvic inflammatory disease, sequelae and chlamydia infection were found to alter the cost effectiveness outcome.CONCLUSIONS: Based on the results from our model, the azithromycin strategy should be employed for the treatment of laboratory confirmed cases. However, for presumptive cases, azithromycin should be used only if the probabilities ofC trachomatisand pelvic inflammatory disease are more than 19%, doxycycline effectiveness is less than 78%, or the cost of azithromycin is less than $19.00.

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Influence of age on the cost-effectiveness of diagnostic strategies for suspected pulmonary embolism

Journal of Thrombosis and Haemostasis ◽

10.1111/j.1538-7836.2007.02667.x ◽

2007 ◽

Vol 5 (9) ◽

pp. 1869-1877 ◽

Cited By ~ 67

Author(s):

M. RIGHINI ◽

M. NENDAZ ◽

G. LE GAL ◽

H. BOUNAMEAUX ◽

A. PERRIER

Keyword(s):

Pulmonary Embolism ◽

Cost Effectiveness ◽

Suspected Pulmonary Embolism ◽

Diagnostic Strategies ◽

The Cost

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The optimal diagnostic strategies for patient with coronary artery diseases and stable chest pain syndrome: a cost-effectiveness analysis

The Egyptian Heart Journal ◽

10.1186/s43044-020-00111-y ◽

2020 ◽

Vol 72 (1) ◽

Author(s):

Parvin Jafari ◽

Reza Goudarzi ◽

Mohammadreza Amiresmaeili ◽

Hamidreza Rashidinejad

Keyword(s):

Computed Tomography ◽

Cost Effectiveness ◽

Coronary Artery ◽

Coronary Angiography ◽

Correct Diagnosis ◽

Cost Effective ◽

Diagnostic Strategies ◽

Effectiveness Analysis ◽

Artery Disease ◽

The Cost

Abstract Background Numerous invasive and noninvasive diagnostic tests with different cost and effectiveness exist for detection of coronary artery disease. This diversity leads to unnecessary utilization of health services. For this reason, this study focused on the cost-effectiveness analysis of diagnostic strategies for coronary artery disease from the perspective of the health care system with 1-year time horizon. Results Incremental cost effectiveness ratios of all strategies were less than the threshold except for the electrocardiography-computed tomography angiography-coronary angiography strategy, and cost of the cardiac magnetic resonance imaging-based strategy was higher than the cost of other strategies. Also, the number of correct diagnosis in the electrocardiography-coronary angiography strategy was higher than the other strategies, and its ICER was 15.197 dollars per additional correct diagnosis. Moreover, the sensitivity analysis found that the probability of doing MRI and sensitivity of the exercise electrocardiography had impact on the results. Conclusion The most cost-effective strategy for acute patient is ECG-CA strategy, and for chronic patient, the most cost-effective strategies are electrocardiography-single photon emission computed tomography-coronary angiography and electrocardiography-exercise electrocardiography-coronary angiography. Applying these strategies in the same clinical settings may lead to a better utilization of resources.

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A systematic review and economic evaluation of diagnostic strategies for Lynch syndrome

Health Technology Assessment ◽

10.3310/hta18580 ◽

2014 ◽

Vol 18 (58) ◽

pp. 1-406 ◽

Cited By ~ 66

Author(s):

Tristan Snowsill ◽

Nicola Huxley ◽

Martin Hoyle ◽

Tracey Jones-Hughes ◽

Helen Coelho ◽

...

Keyword(s):

Cost Effectiveness ◽

De Novo ◽

Health Benefit ◽

Cost Effective ◽

Test Accuracy ◽

Newly Diagnosed ◽

Diagnostic Strategies ◽

Age Limit ◽

The Cost ◽

The Impact

BackgroundLynch syndrome (LS) is an inherited autosomal dominant disorder characterised by an increased risk of colorectal cancer (CRC) and other cancers, and caused by mutations in the deoxyribonucleic acid (DNA) mismatch repair genes.ObjectiveTo evaluate the accuracy and cost-effectiveness of strategies to identify LS in newly diagnosed early-onset CRC patients (aged < 50 years). Cascade testing of relatives is employed in all strategies for individuals in whom LS is identified.Data sources and methodsSystematic reviews were conducted of the test accuracy of microsatellite instability (MSI) testing or immunohistochemistry (IHC) in individuals with CRC at risk of LS, and of economic evidence relating to diagnostic strategies for LS. Reviews were carried out in April 2012 (test accuracy); and in February 2012, repeated in February 2013 (economic evaluations). Databases searched included MEDLINE (1946 to April week 3, 2012), EMBASE (1980 to week 17, 2012) and Web of Science (inception to 30 April 2012), and risk of bias for test accuracy was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) quality appraisal tool. A de novo economic model of diagnostic strategies for LS was developed.ResultsInconsistencies in study designs precluded pooling of diagnostic test accuracy results from a previous systematic review and nine subsequent primary studies. These were of mixed quality, with significant methodological concerns identified for most. IHC and MSI can both play a part in diagnosing LS but neither is gold standard. No UK studies evaluated the cost-effectiveness of diagnosing and managing LS, although studies from other countries generally found some strategies to be cost-effective compared with no testing.The de novo model demonstrated that all strategies were cost-effective compared with no testing at a threshold of £20,000 per quality-adjusted life-year (QALY), with the most cost-effective strategy utilising MSI andBRAFtesting [incremental cost-effectiveness ratio (ICER) = £5491 per QALY]. The maximum health benefit to the population of interest would be obtained using universal germline testing, but this would not be a cost-effective use of NHS resources compared with the next best strategy. When the age limit was raised from 50 to 60 and 70 years, the ICERs compared with no testing increased but remained below £20,000 per QALY (except for universal germline testing with an age limit of 70 years). The total net health benefit increased with the age limit as more individuals with LS were identified. Uncertainty was evaluated through univariate sensitivity analyses, which suggested that the parameters substantially affecting cost-effectiveness: were the risk of CRC for individuals with LS; the average number of relatives identified per index patient; the effectiveness of colonoscopy in preventing metachronous CRC; the cost of colonoscopy; the duration of the psychological impact of genetic testing on health-related quality of life (HRQoL); and the impact of prophylactic hysterectomy and bilateral salpingo-oophorectomy on HRQoL (this had the potential to make all testing strategies more expensive and less effective than no testing).LimitationsThe absence of high-quality data for the impact of prophylactic gynaecological surgery and the psychological impact of genetic testing on HRQoL is an acknowledged limitation.ConclusionsResults suggest that reflex testing for LS in newly diagnosed CRC patients aged < 50 years is cost-effective. Such testing may also be cost-effective in newly diagnosed CRC patients aged < 60 or < 70 years. Results are subject to uncertainty due to a number of parameters, for some of which good estimates were not identified. We recommend future research to estimate the cost-effectiveness of testing for LS in individuals with newly diagnosed endometrial or ovarian cancer, and the inclusion of aspirin chemoprevention. Further research is required to accurately estimate the impact of interventions on HRQoL.Study registrationThis study is registered as PROSPERO CRD42012002436.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Cost-effectiveness of diagnostic strategies for venous thromboembolism: a systematic review

Blood Advances ◽

10.1182/bloodadvances.2020003576 ◽

2021 ◽

Author(s):

Yuan Zhang ◽

Housne A. Begum ◽

Himmat Grewal ◽

Itziar Etxeandia Ikobaltzeta ◽

Gian Paolo Morgano ◽

...

Keyword(s):

Systematic Review ◽

Venous Thromboembolism ◽

Cost Effectiveness ◽

Guideline Development ◽

Cost Effective ◽

Economic Evaluations ◽

Diagnostic Strategies ◽

Pulmonary Angiogram ◽

The Cost ◽

D Dimer

Guideline developers consider cost-effectiveness evidence in decision making to determine value for money. This consideration in the guideline development process can be informed either by formal and dedicated economic evaluations or by systematic reviews of existing studies. To inform the American Society of Hematology guideline on the diagnosis of venous thromboembolism (VTE), we conducted a systematic review focused on the cost-effectiveness of diagnostic strategies for VTE within the guideline scope. We systematically searched Medline (Ovid), Embase (Ovid), National Health Service Economic Evaluation Database, and the Cost-effectiveness Analysis Registry, summarized, and critically appraised the economic evidence on diagnostic strategies for VTE. We identified 49 studies that met our inclusion criteria, with 26 on pulmonary embolism (PE) and 24 on deep vein thrombosis (DVT). For the diagnosis of PE, strategies including D-dimer to exclude PE were cost-effective compared to strategies without D-dimer testing. The cost-effectiveness of CT pulmonary angiogram (CTPA) in relation to ventilation-perfusion (V/Q) scan was inconclusive. CTPA or V/Q scan following ultrasound or D-dimer results could be cost-effective or even cost saving. For DVT, studies supporting strategies with D-dimer and/or ultrasound were cost-effective, supporting the recommendation that for patients at low (unlikely) VTE risk, using D-dimer as the initial test reduces the need for diagnostic imaging. Our systematic review informed the ASH guideline recommendations about D-dimer, V/Q scan and CTPA for PE diagnosis and D-dimer and ultrasound for DVT diagnosis.

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