Published ahead of print on July 31, 2003, doi:10.1164/rccm.200303-367OC
© 2003 American Thoracic Society Cost-effectiveness of Ultrasound in Preventing Femoral Venous Catheter–associated Pulmonary EmbolismDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham; Division of Pulmonary and Critical Care Medicine, Department of Medicine; and Department of Health Policy and Administration, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Correspondence and requests for reprints should be addressed to Christopher Cox, M.D., M.P.H., Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Box 3221 Durham, NC 27710. E-mail: christopher.cox{at}duke.edu 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.
Key Words: cost-effectiveness • venous thrombosis • ultrasonography, Doppler • critical illness This article has been cited by other articles:
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