Cost effectiveness of the addition of a comprehensive CT scan to the abdomen and pelvis for the detection of cancer after unprovoked venous thromboembolism

被引：21

作者：

Coyle, Kathryn ^{[1
]}

Carrier, Marc ^{[2
,3
]}

Lazo-Langner, Alejandro ^{[4
,5
]}

Shivakumar, Sudeep ^{[6
,7
]}

Zarychanski, Ryan ^{[8
,9
]}

Tagalakis, Vicky ^{[10
,11
]}

Solymoss, Susan ^{[12
,13
,18
]}

Routhier, Nathalie ^{[14
,15
]}

Douketis, James ^{[16
,17
]}

Coyle, Douglas ^{[1
,2
,3
]}

机构：

[1] Brunel Univ, Uxbridge UB8 3PH, Middx, England

[2] Univ Ottawa, 451 Smyth Rd, Ottawa, ON K1H 8M5, Canada

[3] Ottawa Hosp, Res Inst, 725 Parkdale Ave, Ottawa, ON K1Y 4E9, Canada

[4] Univ Western Ontario, Dept Med, 1151 Richmond St, London, ON N6A 3K7, Canada

[5] Univ Western Ontario, Dept Epidemiol & Biostat, 1151 Richmond St, London, ON N6A 3K7, Canada

[6] Queen Elizabeth 2 Hlth Sci Ctr, Dept Hematol, 1V8,5805 South St, Halifax, NS NS B3H, Canada

[7] Dalhousie Univ, Dept Med, 6299 South St, Halifax, NS B3H 4R2, Canada

[8] Univ Manitoba, Dept Med, 66 Chancellors Cir, Winnipeg, MB R3T 2N2, Canada

[9] Cancercare Manitoba, Dept Hematol & Med Oncol, 675 McDermot Ave, Winnipeg, MB R3E 0V9, Canada

[10] Sir Mortimer B Davis Jewish Hosp, Dept Med, 3755 Cote Ste Catherine Rd, Montreal, PQ H3T 1E2, Canada

[11] Lady Davis Inst, Ctr Clin Epidemiol, 3755 Chemin Cote St Catherine, Montreal, PQ H3T 1E2, Canada

[12] McGill Univ, Dept Med, 845 Rue Sherbrooke O, Montreal, PQ H3A 0G4, Canada

[13] Montreal Gen Hosp, Div Hematol, 1650 Ave Cedar, Montreal, PQ H3G, Canada

[14] Univ Montreal, Dept Med, 2900 Blvd Edouard Montpetit, Montreal, PQ H3T 1J4, Canada

[15] Sacre Coeur Hosp, 5400 Boul Gouin O, Montreal, PQ H4J 1C5, Canada

[16] St Josephs Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON L8N 4A6, Canada

[17] McMaster Univ, Dept Med, 1280 Main St W, Hamilton, ON L8S 4L8, Canada

[18] St Marys Hosp, 3830 Lacombe Ave, Montreal, PQ H3T 1M5, Canada

来源：

THROMBOSIS RESEARCH | 2017年 / 151卷

关键词：

Thromboembolism; Cancer screening tests; Tomography; X-ray computed; Oncology;

D O I：

10.1016/j.thromres.2017.01.007

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Importance: Unprovoked venous thromboembolism(VTE) can be the first manifestation of cancer. It is unclear if extensive screening for occult cancer including a comprehensive computed tomography (CT) scan of the abdomen/ pelvis is cost-effective in this patient population. Objective: To assess the health care related costs, number of missed cancer cases and health related utility values of a limited screening strategy with and without the addition of a comprehensive CT scan of the abdomen/pelvis and to identify to what extent testing should be done in these circumstances to allow early detection of occult cancers. Participants and setting: Cost effectiveness analysis using data that was collected alongside the SOME randomized controlled trial which compared an extensive occult cancer screening including a CT of the abdomen/pelvis to a more limited screening strategy in patients with a first unprovoked VTE, was used for the current analyses. Main outcomes and measures: Analyses were conducted with a one-year time horizon from a Canadian health care perspective. Primary analysis was based on complete cases, with sensitivity analysis using appropriate multiple imputation methods to account for missing data. Results: Data from a total of 854 patients with a first unprovoked VTE were included in these analyses. The addition of a comprehensive CT scan was associated with higher costs ($551 CDN) with no improvement in utility values or number of missed cancers. Results were consistent when adopting multiple imputation methods. Conclusions and relevance: The addition of a comprehensive CT scan of the abdomen/pelvis for the screening of occult cancer in patients with unprovoked VTE is not cost effective, as it is both more costly and not more effective in detecting occult cancer. (C) 2017 Elsevier Ltd. All rights reserved.

引用

页码：67 / 71

页数：5

共 10 条

[1] Bootstrapping: estimating confidence intervals for cost-effectiveness ratios [J].