Lisette van Dam

Chapter 3 48 Figure 4. Cost-effectiveness plane and efficient frontier (dashed lines) indicating the possibly cost-effective options among the 10 diagnostic scenarios and a scenario to treat all, treat none and treat those with a likely clinical probability and/or abnormal D-dimer without diagnostic imaging (depending on willingness to pay to prevent mortality) . DISCUSSION Our aim of this analysis was to compare the estimated total 1-year health care costs in the Dutch clinical setting between different diagnostic scenarios in case of suspected recurrent ipsilateral DVT, in relation to the associated predicted mortality. We found that diagnostic strategies applying MRDTI have comparable or higher diagnostic accuracy at generally lower 1-year health care costs. Moreover, the diagnostic strategy including CUS followed by MRDTI in case of an inconclusive CUS was a potential optimal cost-effective strategy. The diagnostic strategies including CUS alone and treat all were also potential optimal strategies, but the treat all scenario is not realistic or ethically defendable for clinical practice. Recently, MRDTI was proven to be an accurate, simple, feasible and reproducible diagnostic test in suspected recurrent ipsilateral DVT. 13 Even so, as a MRDTI scan is more expensive and less available than a CUS examination, hospitals may choose diagnostic strategies with CUS over strategies including MRDTI. Our model shows