International differences in health care costs in Europe and the United States: Do these affect the cost-effectiveness of diagnostic strategies for pulmonary embolism?

The aim of this study was to assess whether potential differences in costs for diagnostic procedures and treatment of pulmonary embolism (PE) among Eu ropean and U.S. hospitals alter the optimal cost-effective diagnostic strat egy for PE. A standardized questionnaire was used to obtain cost data for t he diagnosis and treatment of PE in participating European and U.S. hospita ls. Costs for diagnostic tests and treatment of PE were then calculated in a standardized manner for all participating hospitals, from the hospital pe rspective. Costs were used in an existing cost-effectiveness analysis (CEA) model to determine the most cost-effective diagnostic strategy in particip ating hospitals. There were considerable differences in costs for diagnosti c and therapeutic procedures for PE among the participating centers. These differences, however, did not affect the most cost-effective strategy based on incremental cost-effectiveness. In all hospitals the most cost-effectiv e strategy appeared to be ultrasound followed by helical CT. International differences in cost of diagnostic and therapeutic procedures certainly exis t and should be considered before applying a published CEA. Nevertheless, d espite these cost differences, the diagnostic strategy for PE of ultrasound followed by helical CT appears most cost-effective.