Two point-of-care test-based approaches for the exclusion of deep vein thrombosis in general practice: a cost-effectiveness analysis

BMC Primary Care

Research

R. Oudega¹  M. M. A. Kip²  H. Koffijberg²  J. S. Heerink³  R. Kusters³  J. Nies⁴ 

[1] Department of Clinical Chemistry and Haematology, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ, ‘s-Hertogenbosch, the Netherlands;Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands;Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands;Department of Clinical Chemistry and Haematology, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ, ‘s-Hertogenbosch, the Netherlands;GGD Twente, Enschede, the Netherlands;

关键词: Deep vein thrombosis (DVT);    Cost-effectiveness analysis;    Point-of-care test (POCT);    General practitioner (GP);    General practice;    D-dimer;    Clinical decision rule (CDR);    DVT care pathway;   

DOI  :  10.1186/s12875-023-01992-z

 received in 2021-12-10, accepted in 2023-01-23,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundIn the diagnostic work-up of deep vein thrombosis (DVT), the use of point-of-care-test (POCT) D-dimer assays is emerging as a promising patient-friendly alternative to regular D-dimer assays, but their cost-effectiveness is unknown. We compared the cost-effectiveness of two POCT-based approaches to the most common, laboratory-based, situation.MethodsA patient-level simulation model was developed to simulate the diagnostic trajectory of patients presenting with symptoms of DVT at the general practitioner (GP). Three strategies were defined for further diagnostic work-up: one based on current guidelines (‘regular strategy’) and two alternative approaches where a POCT for D-dimer is implemented at the 1) phlebotomy service (‘DVT care pathway’) and 2) GP practice (‘fast-POCT strategy’). Probabilities, costs and health outcomes were obtained from the literature. Costs and effects were determined from a societal perspective over a time horizon of 6 months. Uncertainty in model outcomes was assessed with a one-way sensitivity analysis.ResultsThe Quality-Adjusted Life Years (QALYs) scores for the three DVT diagnostic work-up strategies were all around 0.43 across a 6 month-time horizon. Cost-savings of the two POCT-based strategies compared to the regular strategy were €103/patient for the DVT care pathway (95% CI: -€117–89), and €87/patient for the fast-POCT strategy (95% CI: -€113–67).ConclusionsPoint-of-care-based approaches result in similar health outcomes compared with regular strategy. Given their expected cost-savings and patient-friendly nature, we recommend implementing a D-dimer POCT device in the diagnostic DVT work-up.

【 授权许可】

CC BY   
© The Author(s) 2023

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