COST-EFFECTIVENESS OF PULMONARY-EMBOLISM DIAGNOSIS

Background: In recent years, improvements in the methods of clinical t rials and the use of objective tests to detect venous thrombosis have enhanced the clinician's ability to diagnose pulmonary embolism. Objec tive: To perform a cost-effectiveness analysis of the commonly recomme nded strategies for pulmonary embolism diagnosis and management. Metho ds: Two criteria of effectiveness were used: correct identification of pulmonary embolism and correct identification of patients in whom tre atment was unnecessary. The cost of each diagnostic alternative was de fined as the direct cost of administering the diagnostic test plus the treatment cost associated with a positive test result. Data derived f rom a decision analysis published separately on 662 patients were used for this study. Results: A strategy based on the use of ventilation-p erfusion lung scans, serial impedance plethysmography, and pulmonary a ngiography was the most. cost-effective. It remained so under all poss ible variations within the sensitivity analysis. Conclusions: The stra tegy that requires pulmonary angiography in the fewest patients is a c ombination of ventilation-perfusion lung scans and serial impedance pl ethysmography. This strategy also proved to be the most cost-effective .