TY - JOUR
T1 - Two point-of-care test-based approaches for the exclusion of deep vein thrombosis in general practice
T2 - a cost-effectiveness analysis
AU - Heerink, J.S.
AU - Nies, J.
AU - Koffijberg, H.
AU - Oudega, R.
AU - Kip, M.M.A.
AU - Kusters, R.
N1 - Publisher Copyright:
© 2023, The Author(s).
Financial transaction number:
2500052133
PY - 2023/12
Y1 - 2023/12
N2 - 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.
AB - 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.
KW - Clinical decision rule (CDR)
KW - Cost-effectiveness analysis
KW - D-dimer
KW - Deep vein thrombosis (DVT)
KW - DVT care pathway
KW - General practice
KW - General practitioner (GP)
KW - Point-of-care test (POCT)
UR - http://www.scopus.com/inward/record.url?scp=85147611794&partnerID=8YFLogxK
U2 - 10.1186/s12875-023-01992-z
DO - 10.1186/s12875-023-01992-z
M3 - Article
C2 - 36750797
AN - SCOPUS:85147611794
SN - 2731-4553
VL - 24
JO - BMC Primary Care
JF - BMC Primary Care
IS - 1
M1 - 42
ER -