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. 2021 Mar 9;5(5):1369-1378.
doi: 10.1182/bloodadvances.2020003849.

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

Lisette F van Dam  1 , Wilbert B van den Hout  2 , Gargi Gautam  3 , Charlotte E A Dronkers  1   4 , Waleed Ghanima  5   6 , Jostein Gleditsch  7 , Anders von Heijne  3 , Herman M A Hofstee  4 , Marcel M C Hovens  8 , Menno V Huisman  1 , Stan Kolman  9 , Albert T A Mairuhu  10 , Mathilde Nijkeuter  11 , Marcel A van de Ree  9 , Cornelis J van Rooden  12 , Robin E Westerbeek  13 , Jan Westerink  11 , Eli Westerlund  3 , Lucia J M Kroft  14 , Frederikus A Klok  1
Affiliations

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

Lisette F van Dam et al. Blood Adv. .

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.

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Conflict of interest statement

Conflict-of-interest disclosure: The authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Ten diagnostic scenarios for the diagnostic workup of suspected recurrent ipsilateral DVT. In these scenarios, various combinations of a clinical decision rule and D-dimer testing (CDR+DD) and diagnostic imaging with CUS and/or MRDTI are applied.
Figure 2.
Figure 2.
Flowchart of diagnostic and (over)treatment costs for each diagnosis.
Figure 3.
Figure 3.
One-year health care costs per patient for the 10 diagnostic scenarios. One-year health care costs per patient for the 10 diagnostic scenarios, including a scenario to treat all, treat none, and treat those with a likely clinical probability and/or abnormal D-dimer without diagnostic imaging. CDR+DD, clinical decision rule + D-dimer testing; CUSi, compression ultrasonography is positive, negative, or inconclusive; FN, false negatives; FP, false positives.
Figure 4.
Figure 4.
Total 1-year health care costs of the 10 diagnostic scenarios plotted against the predicted mortality per 10 000 patients. Cost-effectiveness plane and efficient frontier (dashed lines) indicating the possibly cost-effective options among the 10 diagnostic scenarios and a scenario to treat all, treat none, and treat those with a likely clinical probability and/or abnormal D-dimer without diagnostic imaging (depending on willingness to pay to prevent mortality). For strategy numbers, see Figure 1.
See this image and copyright information in PMC

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