Optimal management strategy for use of compression US for deep venous thrombosis in symptomatic patients: A cost-effectiveness analysis

Rationale and Objectives. The authors' purpose was to identify the optimal strategy for using compression ultrasonography (US) in patients suspected o f having deep venous thrombosis (DVT). Materials and Methods. The authors developed a decision-analytic model repr esenting the natural history of DVT and the benefits and risks of anticoagu lation therapy. They evaluated six initial imaging strategies: (a) unilater al examination of the common femoral and popliteal veins; (b) unilateral ex amination of the common femoral, popliteal, and femoral veins; (c) bilatera l examination of the common femoral and popliteal veins; (d) bilateral exam ination of the common femoral, popliteal, and femoral veins; (e) complete u nilateral examination of the symptomatic leg (including calf veins); and (f ) complete bilateral examination of both legs. Results. For 65-year-old men with unilateral symptoms of DVT, the most effe ctive strategy was bilateral examination of the common femoral and poplitea l veins with anticoagulation therapy in patients with proximal DVT and foll ow-up bilateral examination of the common femoral and popliteal veins in pa tients without an initial diagnosis of DVT, with an incremental cost-effect iveness ratio of $39,000 per quality-adjusted life year gained. Conclusion. These results suggest that bilateral examination limited to the common femoral and popliteal veins, with follow-up bilateral examination l imited to the common femoral and popliteal veins, was as cost-effective as other well-accepted medical interventions. The results were sensitive to th e distribution of clot, diagnostic accuracy of compression US, and probabil ity of bleeding with long-term morbidity.