scholarly journals Cost-effectiveness of magnetic resonance imaging for diagnosing recurrent ipsilateral deep vein thrombosis

2021 ◽  
Vol 5 (5) ◽  
pp. 1369-1378
Author(s):  
Lisette F. van Dam ◽  
Wilbert B. van den Hout ◽  
Gargi Gautam ◽  
Charlotte E. A. Dronkers ◽  
Waleed Ghanima ◽  
...  
Keyword(s):  
Health Care ◽  
Deep Vein Thrombosis ◽  
Cost Effectiveness ◽  
Health Care Costs ◽  
Cost Effective ◽  
Diagnostic Strategies ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Care Costs

Abstract The diagnostic workup of recurrent ipsilateral deep vein thrombosis (DVT) using compression ultrasonography (CUS) can be complicated by persistent intravascular abnormalities after a previous DVT. We showed that magnetic resonance direct thrombus imaging (MRDTI) can exclude recurrent ipsilateral DVT. However, it is unknown whether the application of MRDTI in daily clinical practice is cost effective. The aim of this study was to evaluate the cost effectiveness of MRDTI-based diagnosis for suspected recurrent ipsilateral DVT during first year of treatment and follow-up in the Dutch health care setting. Patient-level data of the Theia study (NCT02262052) were analyzed in 10 diagnostic scenarios, including a clinical decision rule and D-dimer test and imaging with CUS and/or MRDTI. The total costs of diagnostic tests and treatment during 1-year follow-up, including costs of false-positive and false-negative diagnoses, were compared and related to the associated mortality. The 1-year health care costs with MRDTI (range, €1219-1296) were generally lower than strategies without MRDTI (range, €1278-1529). This was because of superior specificity, despite higher initial diagnostic costs. Diagnostic strategies including CUS alone and CUS followed by MRDTI in case of an inconclusive CUS were potential optimal cost-effective strategies, with estimated average costs of €1529 and €1263 per patient and predicted mortality of 1 per 737 patients and 1 per 609 patients, respectively. Our model shows that diagnostic strategies with MRDTI for suspected recurrent ipsilateral DVT have generally lower 1-year health care costs than strategies without MRDTI. Therefore, compared with CUS alone, applying MRDTI did not increase health care costs.

Cost-effectiveness of a graded exercise therapy program for patients with chronic shoulder complaints

2006 ◽  
Vol 22 (1) ◽  
pp. 76-83 ◽  
Author(s):  
Jacques J. X. R. Geraets ◽  
Mariëlle E. J. B. Goossens ◽  
Camiel P. C. de Bruijn ◽  
Imelda J. M. de Groot ◽  
Albère J. S. Köke ◽  
...  
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Treatment Period ◽  
Health Care Costs ◽  
Daily Activities ◽  
Graded Exercise Therapy ◽  
Graded Exercise ◽  
Health Related ◽  
Care Costs

Objectives:The present study evaluated the cost-effectiveness of a behavioral graded exercise therapy (GET) program compared with usual care (UC) in terms of the performance of daily activities by patients with chronic shoulder complaints in primary care.Methods:A total of 176 patients were randomly assigned either to GET (n=87) or to UC (n=89). Clinical outcomes (main complaints, shoulder disability [SDQ] and generic health-related quality of life [EQ-5D], and costs [intervention costs, direct health care costs, direct non–health-related costs, and indirect costs]) were assessed during the 12-week treatment period and at 52 weeks of follow-up.Results:Results showed that GET was more effective than UC in restoring daily activities as assessed by the main complaints instrument after the 12-week treatment period (p=.049; mean difference, 7.5; confidence interval [CI], 0.0–15.0). These effects lasted for at least 52 weeks (p=.025; mean difference 9.2; CI, 1.2–17.3). No statistically significant differences were found on the SDQ or EQ5D. GET significantly reduced direct health care costs (p=.000) and direct non–health care costs (p=.029). Nevertheless, total costs during the 1-year follow-up period were significantly higher (p=.001; GET=€530 versus UC=€377) due to the higher costs of the intervention. Incremental cost-effectiveness ratios for the main complaints (0–100), SDQ (0–100), and EQ-5D (−1.0–1.0) were €17, €74, and €5,278 per unit of improvement, respectively.Conclusions:GET proved to be more effective in the short- and long-term and reduces direct health care costs and direct non–health care costs but is associated with higher costs of the intervention itself.

Is it cost-effective to add erlotinib to gemcitabine in advanced pancreatic cancer?

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6048-6048 ◽  
Author(s):  
S. S. Grubbs ◽  
P. A. Grusenmeyer ◽  
N. J. Petrelli ◽  
R. J. Gralla
Keyword(s):  
Health Care ◽  
Pancreatic Cancer ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Health Care Costs ◽  
Advanced Pancreatic Cancer ◽  
Cost Effective ◽  
Significant Difference ◽  
The Impact ◽  
Care Costs

6048 Background: Single agent gemcitabine has been considered the standard of care in advanced pancreatic cancer since 1996. A recent 569 patient randomized trial comparing gemcitabine alone with gemcitabine + erlotinib as first line therapy found a small but statistically significant difference in survival (6.0 vs 6.4 months, respectively, p = .028). The impact on survival may be small, but with nearly 33,000 new cases of pancreatic cancer per year, the impact on health care costs with the use of the combined regimen may be large. Using the known survival data and costs, we analyzed the incremental cost-effectiveness of adding erlotinib. Methods: Costs for a six month course of gemcitabine were developed using Medicare reimbursement from the January, 2006 CMS Drug Payment Table and Physician Fee Schedule assuming no change in infusion reimbursement. Since erlotinib is not approved as a Medicare Part B drug, costs were developed from wholesale and retail sources. Drug dosing and schedules were based on the clinical trial protocol leading to approval. Incremental cost effectiveness of adding erlotinib was calculated. Results: Six month course of gemcitabine alone costs $23,493. The addition of erlotinib increases cost by $12,156 wholesale or $16,613 retail. Given an increase of 0.4 months in median survival over gemcitabine alone, the addition of erlotinib costs $364,680 per year of life gained (YLG) wholesale and $498,379/YLG retail. Sensitivity analyses were conducted assuming shorter therapy of 4 and 5 months. In order to be cost effective even at the $100,000/YLG level, six months of erlotinib would have to be reduced to 20% of the current retail cost (lowered to $18.52 per tablet.) Conclusions: Adding erlotinib to gemcitabine does not approach cost effectiveness at even the highest year per life gained parameters. Such impacts on health care costs, especially for very small gains, become more pressing as all health care costs continue to increase. [Table: see text] [Table: see text]

Cost-effectiveness of intensive home treatment enhanced by inpatient treatment elements in child and adolescent psychiatry in Germany: A randomised trial

2015 ◽  
Vol 30 (5) ◽  
pp. 583-589 ◽  
Author(s):  
I. Boege ◽  
N. Corpus ◽  
R. Schepker ◽  
R. Kilian ◽  
J.M. Fegert
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Cost Effectiveness ◽  
Health Care Costs ◽  
Adolescent Psychiatry ◽  
Inpatient Treatment ◽  
Child And Adolescent ◽  
Child And Adolescent Psychiatry ◽  
Care Costs

AbstractBackgroundAdmission rate to child and adolescent mental health inpatient units in Germany is high (54 467 admissions in 2013), resources for providing necessary beds are scarce. Alternative pathways to care are needed. Objective of this study was to assess the cost-effectiveness of inpatient treatment versus Hot-BITs-treatment (Hometreatment brings inpatient-treatment outside), a new supported discharge service offering an early discharge followed by 12 weeks of intensive support.MethodsOf 164 consecutively recruited children and adolescents, living within families and being in need of inpatient mental health care, 100 patients consented to participate and were randomised via a computer-list into intervention (n = 54) and control groups (n = 46). Follow-up data were available for 76 patients. Primary outcome was cost-effectiveness. Effectiveness was gathered by therapist-ratings on the Children's Global Assessment Scale (CGAS) at baseline (T1), treatment completion (T2) and an 8-month-follow-up (T3). Cost of service use (health care costs and non–health care costs) was calculated on an intention-to-treat basis at T2 and T3.ResultsSignificant treatment effects were observed for both groups between T1/T2 and T1/T3 (P < 0.001). The Hot-BITs treatment, however, was associated with significantly lower costs at T2 (difference: −6900.47€, P = 0.013) and T3 (difference: −8584.10€, P = 0.007). Bootstrap cost-effectiveness ratio indicated that Hot-BITs was less costly and tended to be more effective at T2 and T3.ConclusionsHot-BITs may be a feasible cost-effective alternative to long inpatient stays in child and adolescent psychiatry. Further rigorous evaluations of the model are required. (Registration number: ISRCTN02672532, part 1, Current Controlled Trials Ltd, URL: http://www.controlled-trials.com).

Testing for Occult Cancer in Patients with Idiopathic Deep Vein Thrombosis – A Decision Analysis

1997 ◽  
Vol 78 (05) ◽  
pp. 1319-1326 ◽  
Author(s):  
Giovanni Barosi ◽  
Monia Marchetti ◽  
Luisella Dazzi ◽  
Silvana Quaglini
Keyword(s):  
Deep Vein Thrombosis ◽  
Cost Effectiveness ◽  
Decision Analysis ◽  
Cost Effective ◽  
Vein Thrombosis ◽  
Test Characteristics ◽  
Early Cancer Diagnosis ◽  
Occult Cancer ◽  
Deep Vein ◽  
Risk Of Cancer

SummaryObjective. To determine the effectiveness and cost-effectiveness of testing for occult cancer in idiopathic deep vein thrombosis (IDVT). Design. Threshold analysis was performed on the risk-adjusted cancer prevalence in a cost-effectiveness model of ideal testing for selecting cancers with potentially desirable utility (candidate cancers). Decision analysis was employed to compare different testing programs for candidate cancers with that of no testing. Life expectancy (LE) of early- and late-detected cancers and costs of testing were the dimensions of utility. Cost-effectiveness was expressed as marginal cost per year of life saved. The perspective of the third payer was adopted, and a discount rate of 3% was applied to both costs and benefits. Data sources. Risk of cancer in IDVT, testing policies, test characteristics, and LE were gathered from literature. Costs were provided from our hospital rate book and accounting service. Results. Ideal testing would support a gain of LE of 40 days or more for prostate, colon and bladder cancer in males and for colon, breast and endometrium cancer in females aged from 60 to 69 years. Testing females with colonoscopy and mammography in any sequence provides 70 days of life gained. Testing males with colonoscopy provides 27 days of life gained. Lower and older ages reduce testing effectiveness. The qualitative results are stable over plausible ranges of test characteristics, while variations in the value of benefit for early cancer diagnosis may modify the strategy. Incremental cost-effectiveness ranges from $ 1,789 to $ 6,979 per year of life gained. Conclusions. According to the effectiveness criterion adopted, the only worthwhile investigation strategy includes colon and breast cancer in females. Testing for colon cancer in males is desirable at a lower criterion of effectiveness. All the strategies are cost effective.

Abstract 16486: Consistent Cost-effectiveness of Icosapent Ethyl Across Patient Profiles From REDUCE-IT

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Zugui Zhang ◽  
Deepak L Bhatt ◽  
Sarahfaye Dolman ◽  
William E Boden ◽  
Philippe G Steg ◽  
...  
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Health Care Costs ◽  
Cardiovascular Events ◽  
Lifetime Cost ◽  
Cost Effective ◽  
Dominant Strategy ◽  
Icosapent Ethyl ◽  
Life Years ◽  
Care Costs

Background: The Reduction of Cardiovascular Events with Icosapent Ethyl–Intervention Trial (REDUCE-IT) showed that patients with elevated baseline triglycerides (TG) and well-controlled LDL-C levels on statins had a 30% lower risk of total cardiovascular events with 4g of icosapent ethyl (IPE) daily compared to standard care (SC) during a median 4.9 year follow-up. The purpose of this study was to conduct subgroup analyses of lifetime cost-effectiveness (CE) of IPE compared to SC alone. Methods: Applying treatment effects from REDUCE-IT, health care costs from the National Inpatient Sample (NIS), and net costs for IPE of $4.16 a day, we conducted a combination CE analysis utilizing patient level in-trial cost and clinical outcomes with long-term costs, events, and life expectancy derived from Markov simulation models. The model projected lifetime health care costs, cardiovascular events, survival, and quality-adjusted life-years (QALYs) for IPE vs. SC from a payer perspective among overall trial-eligible patients and in key subgroups. Results: The lifetime mean costs for IPE and SC were $196,080 and $197,064, and the lifetime QALYs for IPE and SC were 10.61 and 10.35, respectively (Table 1). IPE was a dominant strategy over the lifetime in 69.7% of simulations with the probability of CE at the nominal $50,000, $100,000, and $150,000 thresholds being replicated in 87.9%, 98.6%, and 99.9% of simulations, respectively. In the subgroups of age <65 years, male sex, subjects with or without diabetes, secondary prevention cohort, TG levels ≥200 or ≥150 mg/dL, and baseline LDL≥70 mg/dL, IPE was a dominant strategy over the lifetime. In women or the primary prevention cohort, IPE was cost-effective with an ICER of $16,660 or $21,890 per QALY gained, respectively. Conclusions: In all subgroups, IPE at a cost of $4.16/day was shown to be cost-effective at a willingness-to-pay threshold of $50,000 per QALY and was a dominant treatment strategy in most subgroups.

Prospective 12-Year Follow-up Study of Clinical and Hemodynamic Sequelae After Deep Vein Thrombosis in Low-Risk Patients (Zürich Study)

Circulation ◽  
1996 ◽  
Vol 93 (1) ◽  
pp. 74-79 ◽  
Author(s):  
Ulrich K. Franzeck ◽  
Ilse Schalch ◽  
Kurt A. Jäger ◽  
Ernst Schneider ◽  
Jörg Grimm ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Low Risk ◽  
Vein Thrombosis ◽  
Follow Up Study ◽  
Risk Patients ◽  
Deep Vein

Post-thrombotic syndrome after deep vein thrombosis: The role of follow-up Doppler ultrasound

2021 ◽  
Vol 156 (5) ◽  
pp. 251-252
Author(s):  
Francisco Galeano-Valle ◽  
Jorge del-Toro-Cervera ◽  
Pablo Demelo-Rodríguez
Keyword(s):  
Deep Vein Thrombosis ◽  
Doppler Ultrasound ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Deep Vein

scholarly journals Predictors of long-term post-thrombotic syndrome following high proximal deep vein thrombosis: a cross-sectional study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Marit Engeseth ◽  
Tone Enden ◽  
Per Morten Sandset ◽  
Hilde Skuterud Wik
Keyword(s):  
Deep Vein Thrombosis ◽  
Proximal Deep Vein Thrombosis ◽  
Cross Sectional ◽  
Clinical Criteria ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Younger Age ◽  
Deep Vein

Abstract Background Post-thrombotic syndrome (PTS) is a frequent chronic complication of proximal deep vein thrombosis (DVT) of the lower limb, but predictors of PTS are not well established. We aimed to examine predictors of PTS in patients with long-term PTS following proximal DVT. Methods During 2006–09, 209 patients with a first time acute upper femoral or iliofemoral DVT were randomized to receive either additional catheter-directed thrombolysis or conventional therapy alone. In 2017, the 170 still-living participants were invited to participate in a cross-sectional follow-up study. In the absence of a gold standard diagnostic test, PTS was defined in line with clinical practice by four mandatory, predefined clinical criteria: 1. An objectively verified DVT; 2. Chronic complaints (> 1 month) in the DVT leg; 3. Complaints appeared after the DVT; and 4. An alternative diagnosis was unlikely. Possible predictors of PTS were identified with multivariate logistic regression. Results Eighty-eight patients (52%) were included 8–10 years following the index DVT, and 44 patients (50%) were diagnosed with PTS by the predefined clinical criteria. Younger age and higher baseline Villalta score were found to be independent predictors of PTS, i.e., OR 0.96 (95% CI, 0.93–0.99), and 1.23 (95% CI, 1.02–1.49), respectively. Lack of iliofemoral patency at six months follow-up was significant in the bivariate analysis, but did not prove to be significant after the multivariate adjustments. Conclusions In long-term follow up after high proximal DVT, younger age and higher Villalta score at DVT diagnosis were independent predictors of PTS.

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