Abstract Number: PB2284
Meeting: ISTH 2020 Congress
Theme: Venous Thromboembolism and Cardioembolism » VTE Diagnosis
Background: The diagnosis of recurrent ipsilateral deep vein thrombosis (DVT) with compression ultrasonography (CUS) is hindered by persistent intravascular abnormalities after a previous DVT. We have shown that magnetic resonance direct thrombus imaging (MRDTI) can exclude recurrent ipsilateral DVT and prevent overdiagnosis by CUS. However, it is unknown whether the application of MRDTI in daily clinical practice is cost-effective.
Aims: To evaluate the cost-effectiveness of applying MRDTI in different diagnostic strategies for suspected recurrent ipsilateral DVT in the Dutch setting.
Methods: : Patient-level data of the Theia study (van Dam et al, Blood 2020) were analyzed in 10 hypothetical diagnostic scenarios, including clinical probability scoring with the Wells rule in combination with D-dimer testing, and diagnostic imaging with CUS and/or MRDTI (Figure 1). CUS was judged as either positive, negative or inconclusive, which was accounted for in the diagnostic strategies. Both positive and inconclusive results were summarized as abnormal CUS result. The costs of diagnostic tests and anticoagulant treatment during one-year follow-up, including costs of false positive and false negative diagnoses, were compared.
Results: Compared to MRDTI alone, a combination of the Wells rule and D-dimer tests was associated with a higher failure rate (6.1%), and CUS alone with an excess of false positive diagnoses (19%) of recurrent ipsilateral DVT. Even though initial diagnostic costs for strategies with MRDTI were higher than strategies without MRDTI, the total 1-year costs with MRDTI were generally comparable or lower than without MRDTI due to superior diagnostic accuracy
(Figure 2).
Conclusions: Our model shows that the diagnostic strategies for suspected recurrent ipsilateral DVT with MRDTI have higher diagnostic accuracy at generally lower total 1-year healthcare costs compared to diagnostic setups without MRDTI. Compared to CUS alone, applying MRDTI in clinical practice therefore will not increase healthcare costs.
To cite this abstract in AMA style:
van Dam LF, van den Hout WB, Gautam G, Dronkers CEA, Eckerbom Å, Ghanima W, Gleditsch J, von Heijne A, Hofstee HMA, Hovens MMC, Huisman MV, Mairuhu ATA, Nijkeuter M, van de Ree MA, van Rooden CJ, Westerbeek RE, Westerink J, Westerlund E, Kroft LJM, Klok FA. Cost-Effectiveness of Magnetic Resonance Direct Thrombus Imaging for Diagnosing Recurrent Ipsilateral Deep Vein Thrombosis [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/cost-effectiveness-of-magnetic-resonance-direct-thrombus-imaging-for-diagnosing-recurrent-ipsilateral-deep-vein-thrombosis/. Accessed March 21, 2024.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/cost-effectiveness-of-magnetic-resonance-direct-thrombus-imaging-for-diagnosing-recurrent-ipsilateral-deep-vein-thrombosis/