Cost-effectiveness of ultrasound in preventing femoral venous catheter-associated pulmonary embolism.

Published

Journal Article

Femoral central venous catheter use is complicated by a high risk of deep venous thrombosis despite antithrombotic prophylaxis. Although some have recommended screening for femoral catheter-associated thrombosis to prevent pulmonary embolism (PE), this strategy's economic implications are unclear. Therefore, we used a decision model to evaluate the potential cost-effectiveness of a Doppler ultrasound-based screening strategy versus no ultrasound in averting thromboembolic complications associated with femoral catheters. The base-case analysis included a hypothetical cohort of 60-year-old medical patients treated for acute respiratory failure. The perspective was that of the health care payor, and the primary outcomes were quality-adjusted life expectancy, PE, and PE-associated deaths. The ultrasound strategy cost $8,688/quality-adjusted life-year (QALY) gained, $5,305/PE averted, and $99,286/PE death averted. The best- and worst-case scenarios, calculated in multiway sensitivity analyses by varying in-hospital mortality, deep venous thrombosis prevalence, and ultrasound accuracy, ranged from $1,170/QALY to $35,342/QALY, respectively. Probablistic analyses, in which variables with uncertain values were varied randomly within their ranges, demonstrated median costs of $12,793/QALY (interquartile range $8,176/QALY, $20,648/QALY). In summary, ultrasound screening may improve outcomes among the critically ill with femoral venous catheters at acceptable costs and could complement venous thrombosis primary prevention programs.

Full Text

Duke Authors

Cited Authors

  • Cox, CE; Carson, SS; Biddle, AK

Published Date

  • December 15, 2003

Published In

Volume / Issue

  • 168 / 12

Start / End Page

  • 1481 - 1487

PubMed ID

  • 12893647

Pubmed Central ID

  • 12893647

International Standard Serial Number (ISSN)

  • 1073-449X

Digital Object Identifier (DOI)

  • 10.1164/rccm.200303-367OC

Language

  • eng

Conference Location

  • United States