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Cost-Effectiveness Analysis of Diagnostic Management of Pulmonary Embolism

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Advances in CT IV

Abstract

The diagnosis of pulmonary embolism (PE) is a challenging task for any physician. Annually, two to three per 1000 inhabitants present with symptoms suggesting the presence of venous thromboembolic disease, the common denominator for deep vein thrombosis and PE [1, 2]. The range of diagnostic procedures that physicians have at their disposal varies from clinical history and physical examination — often supplemented with blood gas analysis, chest radiography and electrocardiography — to lung scintigraphy and pulmonary angiography. However, their exact role and place in a diagnostic strategy remain controversial and have been a matter of discussion in recent years [3–18].

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References

  1. Gjores JE (1988) The incidence of venous thrombosis and its sequelae in certain districts of Sweden. Acta Chir Scand 1956 [Suppl 206]: 1–88

    Article  Google Scholar 

  2. Anderson Jr FA, Wheeler HB, Goldberg RJ et al (1991) A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT study. Arch Intern Med 151:933–938

    Article  PubMed  Google Scholar 

  3. Robin ED (1977) Overdiagnosis and overtreatment of pulmonary embolism: the emperor may have no clothes. Ann Intern Med 87:775–781

    PubMed  CAS  Google Scholar 

  4. Stein PD, Alavi A, Gottschalk A et al (1991) Usefulness of noninvasive tools for diagnosis of acute pulmonary embolism in patients with a normal chest radiograph. Am J Cardiol 67: 1117–1120

    Article  PubMed  CAS  Google Scholar 

  5. Hull RD, Raskob GE, Coates G et al (1991) Low-probability lung scan findings: a need for change. Ann Intern Med 114:142–143

    PubMed  CAS  Google Scholar 

  6. Oudkerk M, van Beek EJR, van Putten WLJ, Biiller HR (1993) Cost-effectiveness analysis of various strategies in the diagnostic management of pulmonary embolism. Arch Intern Med 153:947–954

    Article  PubMed  CAS  Google Scholar 

  7. Stein PD, Hull RD, Saltzman HA, Pineo G (1993) Strategy for diagnosis of patients with suspected acute pulmonary embolism. Chest 103:1553–1559

    Article  PubMed  CAS  Google Scholar 

  8. Kelley MA et al (1991) Diagnosing pulmonary embolism: new facts and strategies. Ann Intern Med 114:300–306

    PubMed  CAS  Google Scholar 

  9. Palevsky HI et al (1991) A noninvasive strategy for the management of patients suspected of pulmonary embolism. Semin Nucl Med 21:325–331

    Article  PubMed  CAS  Google Scholar 

  10. Gurney JW et al (1993) No fooling around: direct visualisation of pumonary embolism. Radiology 188:618–619

    PubMed  CAS  Google Scholar 

  11. Henschke CI et al (1994) Evaluation of competing tests for the diagnosis of pulmonary embolism in deep venous thrombosis. Clin Imaging 18:241–254

    Article  PubMed  CAS  Google Scholar 

  12. Hull RD et al (1994) A noninvasive strategy for the treatment of patients with suspected pulmonary embolism. Arch Intern Med 154:289–297

    Article  PubMed  CAS  Google Scholar 

  13. Hyers TH (1995) Diagnosis of pulmonary embolism. Thorax 50:930–932

    Article  PubMed  CAS  Google Scholar 

  14. Henschke CI et al (1995) Changing practice patterns in the work up of pulmonary embolism. Chest 107:940–945

    Article  PubMed  CAS  Google Scholar 

  15. Matsumoto AH et al (1995) Contemporary diagnostic approaches to acute pulmonary emboli. Rad Clin North Am 33:167–184

    CAS  Google Scholar 

  16. Rosenow EC et al (1995) Venous and pulmonary thromboembolism: an algorithmic approach to diagnosis and management. Mayo Clin Proc 70:45–49

    Article  PubMed  Google Scholar 

  17. Goodman LR et al (1996) Diagnosis of acute pulmonary embolism: time for a new approach. Radiology 199:25–27

    PubMed  CAS  Google Scholar 

  18. Tapson VF et al (1997) Pulmonary embolism - new diagnostic approaches. New Engl J Med 336:1449–1451

    Article  PubMed  CAS  Google Scholar 

  19. Dalen JE, Alpert JS (1975) Natural history of pulmonary embolism. Progr Cardiovasc Dis 17: 259–270

    Article  CAS  Google Scholar 

  20. Barritt DW, Jordan SC (1960) Anticoagulant drugs in the treatment of pulmonary embolism: a controlled study. Lancet i: 1309–1312

    Article  Google Scholar 

  21. Gallus A, Tillett J, Jackson J, Mills W, Wycherley A (1986) Safety and efficacy of warfarin started early after submassive venous thrombosis or pulmonary embolism. Lancet ii: 1293–1296

    Article  Google Scholar 

  22. Hull R, Delmore T, Genton E et al (1970) Warfarin-sodium versus low-dose heparin in the long-term treatment of venous thrombosis. N Engl J Med 301:855–858

    Article  Google Scholar 

  23. Huisman MV, Biiller HR, ten Cate JW, Vreeken J (1986) Serial impedance plethysmography for suspected deep venous thrombosis in outpatients. N Engl J Med 314:823–828

    Article  PubMed  CAS  Google Scholar 

  24. Hull R, Hirsh J, Jay R et al (1982) Different intensities of oral anticoagulant therapy in the treatment of proximal vein thrombosis. N Engl J Med 307:1676–1681

    Article  PubMed  CAS  Google Scholar 

  25. Levine MN, Raskob G, Hirsh J (1989) Haemorrhagic complications of long-term anticoagulant therapy. Chest 95 [Suppl]: 26–36

    Google Scholar 

  26. Hirsh J (1991) Heparin. N Engl J Med 324:1565–1574

    Article  CAS  Google Scholar 

  27. Hirsh J (1991) Oral anticoagulant drugs. N Engl J Med 324:1865–1875

    Article  PubMed  CAS  Google Scholar 

  28. Van der Meer FJM, Rosendaal FR, Vandenbroucke JP, Briet E (1993) Bleeding complications in oral anticoagulant therapy. An analysis of risk factors. Arch Int Med 1993; 153: 1557–1562

    Article  Google Scholar 

  29. The PIOPED Investigators (1990) Value of ventilation/perfusion scan in acute pulmonary embolism: results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA 263:2753–2759

    Article  Google Scholar 

  30. Biello DR, Mattar AG, McKnight RC, Siegel BA (1979) Ventilation-perfusion studies in suspected pulmonary embolism. Am J Roentgenol 133:1033–1037

    CAS  Google Scholar 

  31. McNeil BJ (1980) Ventilation-perfusion studies and the diagnosis of pulmonary embolism: concise communication. J Nucl Med 21:319–323

    PubMed  CAS  Google Scholar 

  32. Hull RD, Raskob GE, Coates G, Panju AA, Gill GJ (1989) A new noninvasive management strategy for patients with suspected pulmonary embolism. Arch Intern Med 149:2549–2555

    Article  PubMed  CAS  Google Scholar 

  33. Moser KM (1990) Venous thromboembolism. Am Rev Respir Dis 141:235–249

    PubMed  CAS  Google Scholar 

  34. Stein PD, Willis III PW, DeMets DL (1981) History and physical examination in acute pulmonary embolism in patients without preexisting cardiac or pulmonary disease. Am J Cardiol 47:218–223

    Article  PubMed  CAS  Google Scholar 

  35. Stein PD, Alavi A, Gottschalk A et al (1991) Usefulness of noninvasive diagnostic tools for diagnosis of acute pulmonary embolism in patients with a normal chest radiograph. Am J Cardiol 67:117–1120

    Article  Google Scholar 

  36. Stein PD, Terrin ML, Hales CA et al (1991) Clinical, laboratory, roentgenographic, electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest 100:598–603

    Article  PubMed  CAS  Google Scholar 

  37. Quinn MF, Lundell CJ, Klotz TA et al (1987) Reliability of selective pulmonary arteriography in the diagnosis of pulmonary embolism. Am J Radiol 149:469–471

    CAS  Google Scholar 

  38. Van Beek EJR, Bakker AJ, Reekers JA (1996) Interobserver variability of pulmonary angiography in patients with non-diagnostic lung scan results: conventional versus digital subtraction angiography. Radiology 198:721–724

    PubMed  Google Scholar 

  39. Novelline RA, Galtarowich OH, Athanasoulis CA et al (1978) The clinical course of patients with suspected pulmonary embolism and a negatOive pulmonary arteriogram. Radiology 126:561–567

    PubMed  CAS  Google Scholar 

  40. Hull RD, Raskob GE, Carter CJ et al (1988) Pulmonary embolism in outpatients with pleuritic chest pain. Arch Intern Med 148:838–844

    Article  PubMed  CAS  Google Scholar 

  41. Stein PD, Athanasoulis CA, Alavi A et al (1992) Complications and validity of pulmonary angiography in acute pulmonary embolism. Circulation 85:462–468

    PubMed  CAS  Google Scholar 

  42. Dalen JE, Brooks HL, Johnson LW et al (1971) Pulmonary angiography in acute pulmonary embolism: indications, techniques, and results in 367 patients. Am Heart J 81:175–185

    Article  PubMed  CAS  Google Scholar 

  43. Mills SR, Jackson DC, Older RA et al (1980) The incidence, etiologies, and avoidance of complications of pulmonary angiography in a large series. Radiology 136:299

    Google Scholar 

  44. Hudson ER, Smith RP, McDermott VG et al (1996) Pulmonary angiography performed with iopamidol: complications in 1434 patients. Radiology 198:61–65

    PubMed  CAS  Google Scholar 

  45. Wallis JW, van Beek EJR, Reekers JA, van Rooy WJJ, Oudkerk M (1997) Terughoudendheid ten aanzien van pulmonalis angiografie bij longembolie niet terecht. Ned Tijdschr Geneesk 141:578–581

    CAS  Google Scholar 

  46. Kipper MS, Moser KM, Kortman KE, Ashburn WL (1982) Longterm follow-up of patients with suspected pulmonary embolism and a normal lung scan. Chest 82:411–415

    Article  PubMed  CAS  Google Scholar 

  47. Hull RD, Raskob GE, Coates G, Panju AA (1990) Clinical validity of a normal perfusion lung scan in patients with suspected pulmonary embolism. Chest 97:23–26

    Article  PubMed  CAS  Google Scholar 

  48. Hull RD, Hirsh J, Carter CJ et al (1983) Pulmonary angiography, ventilation lung scanning, and venography for clinically suspected pulmonary embolism with abnormal perfusion lung scan. Ann Intern Med 98:891–899

    PubMed  CAS  Google Scholar 

  49. Van Beek EJR, Tiel-van Buul MMC, Biiller HR, van Royen EA, ten Cate JW (1993) The value of lung scintigraphy in the diagnosis of pulmonary embolism. Eur J Nucl Med 20:173–181

    Article  PubMed  Google Scholar 

  50. Kruit WHJ, de Boer AC, Sing AK, van Roon F (1991) The significance of venography in the management of patients with clinically suspected pulmonary embolism. J Intern Med 230: 333–339

    Article  PubMed  CAS  Google Scholar 

  51. Ferris 13 (1983) Deep venous thrombosis and pulmonary embolism: correlative evaluation. Int Angiol 2:85–98

    Google Scholar 

  52. Heyboer H, Biiller HR, Lensing AWA, Turpie AG, Colly LP, ten Cate JW (1993) A comparison of real-time compression ultrasonography with impedance plethysmography for the diagnosis of deep-vein thrombosis in symptomatic outpatients. N Engl J Med 329:1365–1369

    Article  Google Scholar 

  53. Lensing AWA, Prandoni P, Brandjes DPM et al (1989) Detection of deep-vein thrombosis by real-time B-mode ultrasonography. N Engl J Med 320:342–345

    Article  PubMed  CAS  Google Scholar 

  54. Goodman LR et al (1995) Detection of pulmonary embolism in patients with unresolved clinical and scintigraphic diagnosis: helical CT vs angiography. Am J Roentgenol 164: 1369–1374

    CAS  Google Scholar 

  55. Remy Jardin M et al (1992) Central pulmonary thromboembolism: diagnosis with spiral volumetric CT with the single breath hold technique; comparison with pulmonary angiography. Radiology 185:381–387

    PubMed  CAS  Google Scholar 

  56. Remy-Jardin M et al (1996) Diagnosis of pulmonary embolism with spiral CT: comparison with pulmonary angiography and scintigraphy. Radiology 200:699–706

    PubMed  CAS  Google Scholar 

  57. Rossum AB van et al (1996) Pulmonary embolus: validation of spiral CTA in 149 patients. Radiology 201:467–470

    PubMed  Google Scholar 

  58. Rossum AB van et al (1996) Role of spiral volumetric CT in the assessment of patients with clinical suspicion of pulmonary embolism and an abnormal VQ lung scan. Thorax 51:23–28

    Article  PubMed  Google Scholar 

  59. Mayo JR et al (1997) Pulmonary embolism: prospective comparison of helical CT with ven- tilation/perfusion scintigraphy. Radiology 205:447–452

    PubMed  CAS  Google Scholar 

  60. Ferretti GR et al (1997) Acute pulmonary embolism: role of helical CT in 164 patients with intermediate probability at ventilation/perfusion scintigraphy and normal results and dvt- US. Radiology 205:453–458

    PubMed  CAS  Google Scholar 

  61. Briet E, Beek EJR van, Oudkerk M (1993) Consensus diagnostiek longembolie. Ned Tijdschr Geneesk 137(5): 225–259

    Google Scholar 

  62. Erkel AR van et al (1996) Spiral CT angiography for suspected pulmonary embolism: a cost- effectiveness analysis. Radiology 201:29–36

    PubMed  Google Scholar 

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© 1998 Springer-Verlag Berlin Heidelberg

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Oudkerk, M., van Beek, E.J.R., Bongaerts, A.H.H. (1998). Cost-Effectiveness Analysis of Diagnostic Management of Pulmonary Embolism. In: Krestin, G.P., Glazer, G.M. (eds) Advances in CT IV. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-72195-3_13

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  • DOI: https://doi.org/10.1007/978-3-642-72195-3_13

  • Publisher Name: Springer, Berlin, Heidelberg

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