Cost-minimization analysis of venous thromboembolism diagnosis: Comparison of standalone imaging with a strategy incorporating D-dimer for exclusion of venous thromboembolism.

Background: The burden of healthcare costs has substantially risen in the last few decades. One possible contributing factor to this increase are the diagnostic approaches for venous thromboembolism (VTE) using only imaging to exclude a diagnosis of VTE. Objective: To demonstrate cost minimization in the diagnosis of VTE by comparing standalone imaging (computed tomography pulmonary angiography and compression ultrasonography) to a published VTE diagnostic strategy incorporating assessment of pre-test probability and D-dimer testing. Methods: We retrospectively reviewed data from a multicenter diagnostic accuracy study of a D-dimer reagent where consecutive outpatients (n=747) with suspected VTE, including both pulmonary embolism (n=346) and deep venous thrombosis (n=401) were evaluated. By applying a VTE diagnostic strategy and using the proportion of patients that were diagnosed as VTE-negative (n=137 for PE; n=120 for DVT), we developed a cost calculator to compare the average diagnostic test cost per suspected VTE patient, both before and after the implementation of the VTE diagnostic strategy. Results: Implementation of the VTE diagnostic strategy reduced the average diagnostic test cost for a suspected PE patient by 38% and for a suspected DVT patient by 24%. Assuming the proportion of VTE suspected patients to be 30% PE and 70% DVT, the weighted average reduction in the diagnostic test cost per suspected VTE patient was 32%. Conclusion: Implementation of a VTE diagnostic strategy can allow hospitals to reduce costs without compromising patient safety.