Abstract:
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.
journal_name
Thromb Resjournal_title
Thrombosis researchauthors
Coyle K,Carrier M,Lazo-Langner A,Shivakumar S,Zarychanski R,Tagalakis V,Solymoss S,Routhier N,Douketis J,Coyle Ddoi
10.1016/j.thromres.2017.01.007subject
Has Abstractpub_date
2017-03-01 00:00:00pages
67-71eissn
0049-3848issn
1879-2472pii
S0049-3848(17)30017-8journal_volume
151pub_type
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journal_title:Thrombosis research
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更新日期:1994-09-01 00:00:00
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pub_type: 杂志文章,meta分析
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journal_title:Thrombosis research
pub_type: 杂志文章
doi:10.1016/s0049-3848(98)00042-5
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更新日期:2019-03-01 00:00:00
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journal_title:Thrombosis research
pub_type: 杂志文章
doi:10.1016/0049-3848(96)00023-0
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journal_title:Thrombosis research
pub_type: 杂志文章
doi:10.1016/j.thromres.2004.08.014
更新日期:2005-01-01 00:00:00
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journal_title:Thrombosis research
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journal_title:Thrombosis research
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doi:10.1016/0049-3848(94)90201-1
更新日期:1994-11-01 00:00:00
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pub_type: 杂志文章
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更新日期:2013-08-01 00:00:00
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journal_title:Thrombosis research
pub_type: 杂志文章
doi:10.1016/0049-3848(85)90126-4
更新日期:1985-07-01 00:00:00
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journal_title:Thrombosis research
pub_type: 杂志文章
doi:10.1016/j.thromres.2007.09.001
更新日期:2008-01-01 00:00:00
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pub_type: 杂志文章
doi:10.1016/j.thromres.2008.10.001
更新日期:2009-07-01 00:00:00
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journal_title:Thrombosis research
pub_type: 更正并重新发布的文章,杂志文章
doi:10.1016/0049-3848(90)90148-6
更新日期:1990-07-15 00:00:00
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journal_title:Thrombosis research
pub_type: 杂志文章
doi:10.1016/j.thromres.2017.04.024
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pub_type: 杂志文章
doi:10.1016/j.thromres.2009.07.010
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pub_type: 杂志文章
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pub_type: 杂志文章
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pub_type: 临床试验,杂志文章
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journal_title:Thrombosis research
pub_type: 杂志文章,随机对照试验
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更新日期:2011-02-01 00:00:00
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journal_title:Thrombosis research
pub_type: 杂志文章
doi:10.1016/0049-3848(85)90331-7
更新日期:1985-10-15 00:00:00
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journal_title:Thrombosis research
pub_type: 杂志文章
doi:10.1016/j.thromres.2016.05.012
更新日期:2016-07-01 00:00:00
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journal_title:Thrombosis research
pub_type: 杂志文章
doi:10.1016/j.thromres.2013.10.006
更新日期:2013-01-01 00:00:00
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journal_title:Thrombosis research
pub_type: 杂志文章
doi:10.1016/0049-3848(87)90236-2
更新日期:1987-07-01 00:00:00
abstract::Several sex-related differences in the incidence rate, clinical presentation and outcomes of VTE were recently investigated. Gender-related risk factors, such as the use of oral contraceptives (OC) and pregnancy, in particular in women with a thrombophilic state, are associated with an increased risk of venous thrombo...
journal_title:Thrombosis research
pub_type: 杂志文章,评审
doi:10.1016/S0049-3848(11)70023-8
更新日期:2011-02-01 00:00:00
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journal_title:Thrombosis research
pub_type: 杂志文章,评审
doi:10.1016/j.thromres.2010.10.009
更新日期:2010-12-01 00:00:00
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journal_title:Thrombosis research
pub_type: 杂志文章
doi:10.1016/j.thromres.2014.02.001
更新日期:2014-05-01 00:00:00
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journal_title:Thrombosis research
pub_type: 杂志文章
doi:10.1016/0049-3848(88)90348-9
更新日期:1988-06-15 00:00:00