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

J.S. Heerink*, J. Nies, H. Koffijberg, R. Oudega, M.M.A. Kip, R. Kusters

*Corresponding author for this work

Research output: Contribution to journalArticleAcademic

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Background: In 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.

Methods: A 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.

Results: The 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).

Conclusions: Point-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.

Original languageEnglish
Article number42
Number of pages11
JournalBMC Primary Care
Issue number1
Early online date7 Feb 2023
Publication statusE-pub ahead of print/First online - 7 Feb 2023


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

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