Abstract Number: PB2270
Meeting: ISTH 2020 Congress
Theme: Venous Thromboembolism and Cardioembolism » VTE Diagnosis
Background: Guidelines from the National Institute of Clinical Excellence (NICE) suggest proximal leg vein ultrasound scans (USS) for patients with a suspected acute deep vein thrombosis (DVT), with a Wells score of 2 or more. If negative, a rescan of the proximal leg veins in 6-8 days is suggested. The guidelines recommend research into the cost-effectiveness of whole-leg USS compared with the current approach in the diagnosis of acute DVT.
Aims: To assess the cost-effectiveness of a whole-leg USS compared with proximal leg vein USS in the diagnosis of acute DVT.
Methods: We collected data on USS performed for the diagnosis of DVT. The data included the years 2002, 2003 and 2009, when proximal leg vein USS were primarily undertaken (~10% of scans by vascular sonographers did scan to the calf veins). We also collected data for years 2014 and 2015, in which whole-leg scans were primarily undertaken. The cost of an USS is estimated at £200. Our population is around 0.5 million.
Results: See Table 1. In 2002, 2003 and 2009 there were 1794 rescans performed which detected 72 DVT’s of which 19 (26%) were calf DVTs. For the year 2014 and 2015, only 385 rescans were performed which detected 22 DVT’s of which 5 (23%) were calf DVT’s. We calculated the cost of rescanning per annum to be £119,600 when primary scanning just involves the proximal veins (£4983 per +ve scan); whereas it is £38,500 when primary scanning involves the proximal and distal leg veins (£3500 per +ve scan).
Conclusions: We showed that performing a whole-leg scan as an initial diagnostic method does not drastically alter the percentage of DVTs detected at rescan, but it does allow a cost benefit. The reduction in the number of rescans performed suggests whole-leg scanning is a more cost-effective primary option.
| Year | 2002 | 2003 | 2009 | 2014 | 2015 |
| Total number of first scans performed | 852 | 989 | 1087 | 959 | 1000 |
| Total number of positive DVT found (%) | 203 (23.8) | 223 (22.5) | 223 (20.5) | 175 (18.2) | 180 (18.0) |
| Total number of calf DVT detected | 17 | 16 | 16 | 9 | 27 |
| Total number of rescans performed | 576 | 665 | 553 | 202 | 183 |
| Total number of positive DVT found (%) | 28 (4.9) | 30 (4.5) | 14 (2.5) | 13 (6.4) | 9 (4.9) |
| Total number of calf DVT detected | 7 | 5 | 7 | 2 | 3 |
[Table 1]
To cite this abstract in AMA style:
Bertone G, Lester Z, Rowswell H, Nokes T, Thomas W. An Assessment of the Cost-Effectiveness of Whole-Leg Ultrasound Scans Compared to Proximal Leg Vein Ultrasound Scans in the Diagnosis of Acute Deep Vein Thrombosis [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/an-assessment-of-the-cost-effectiveness-of-whole-leg-ultrasound-scans-compared-to-proximal-leg-vein-ultrasound-scans-in-the-diagnosis-of-acute-deep-vein-thrombosis/. Accessed October 1, 2023.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/an-assessment-of-the-cost-effectiveness-of-whole-leg-ultrasound-scans-compared-to-proximal-leg-vein-ultrasound-scans-in-the-diagnosis-of-acute-deep-vein-thrombosis/