Optimizing resource allocation: Cost-effectiveness of specified D-dimer cut-offs in cancer patients with suspected venous thromboembolism

• DOI: 10.1007/s11239-024-03000-2
• Publication Date: 2024-05-18T18:01:32Z
• Authors: Teodora Biciusca; Leon D. Gruenewald; Simon S. Martin; Jennifer Gotta; Scherwin Mahmoudi; Katrin Eichler; Christian Booz; Christian Salbach; Matthias Müller-H...; Moritz Biener; Mustafa Yildirim; Barbara Milles; Christof M. Sommer; Thomas J. Vogl; Evangelos Giannitsis; Vitali Koch
• Keywords: D-dimer; Hematology

Abstract An accurate diagnosis of venous thromboembolism (VTE) is crucial, given the potential for high mortality in undetected cases. Strategic D-dimer testing may aid identifying low-risk patients, preventing overdiagnosis and reducing imaging costs. We conducted a retrospective, comparative analysis to assess cost savings that could be achieved by adopting different approaches determine most effective cut-off value cancer patients with suspected VTE, compared commonly used rule-out level 0.5 mg/L. The study included 526 (median age 65, IQR 55–75) confirmed who underwent testing. Among these VTE prevalence was 29% (n = 152). Each diagnostic strategy's sensitivity, specificity, negative likelihood ratio (NLR), as well positive (PLR), proportion exhibiting test result, were calculated. strategy demonstrated best balance between NLR, PLR, utilized an inverse age-specific [0.5 + (66-age) × 0.01 mg/L]. This method yielded PLR 2.9 at very low NLR exclusion VTE. observed significant reduction 4.6% 1.0% PE DVT, respectively. utilization age-adjusted [patient’s mg/L] resulted highest savings, reaching 8.1% 3.4% DVT. Using specified cut-offs improve economics, considering limited occurrence cases among Graphical In context strategic helps identify our retrospective study, D-dimer. 1% Abbreviations: CTPA, computed tomography pulmonary angiography; CUS, compression ultrasound; deep vein thrombosis; PE, embolism; thromboembolism.