Cost-effectiveness of the deep vein thrombosis diagnosis process in primary care

• Published in: Atención primaria 2016-04, Vol.48 (4), p.251-257
• Main Authors: Fuentes Camps, Eva, Luis del Val García, José, Bellmunt Montoya, Sergi, Hmimina Hmimina, Sara, Gómez Jabalera, Efren, Muñoz Pérez, Miguel Ángel
• Format: Article
• Language: Spanish
• Subjects: Aged; Algorithms; Cost-Benefit Analysis; Cross-Sectional Studies; Diagnosis, Differential; Emergency Medical Services; Female; Humans; Male; Predictive Value of Tests; Primary Health Care; Venous Thrombosis - diagnosis; Venous Thrombosis - economics
• ISSN: 1578-1275
• DOI: 10.1016/j.aprim.2015.05.006

To analyse the cost effectiveness of the application of diagnostic algorithms in patients with a first episode of suspected deep vein thrombosis (DVT) in Primary Care compared with systematic referral to specialised centres. Observational, cross-sectional, analytical study. Patients from hospital emergency rooms referred from Primary Care to complete clinical evaluation and diagnosis. A total of 138 patients with symptoms of a first episode of DVT were recruited; 22 were excluded (no Primary Care report, symptoms for more than 30 days, anticoagulant treatment, and previous DVT). Of the 116 patients finally included, 61% women and the mean age was 71 years. Variables from the Wells and Oudega clinical probability scales, D-dimer (portable and hospital), Doppler ultrasound, and direct costs generated by the three algorithms analysed: all patients were referred systematically, referral according to Wells and Oudega scale. DVT was confirmed in 18.9%. The two clinical probability scales showed a sensitivity of 100% (95% CI: 85.1 to 100) and a specificity of about 40%. With the application of the scales, one third of all referrals to hospital emergency rooms could have been avoided (P