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Cost-Effectiveness Analysis of Routine Venous Doppler Ultrasound for Diagnosis of Deep Venous Thrombosis at Admission to Inpatient Rehabilitation

Pinto, Shanti M., MD; Yassin, Mohamed, MD; Galang, Gary, MD

American Journal of Physical Medicine & Rehabilitation: October 2018 - Volume 97 - Issue 10 - p 747–753
doi: 10.1097/PHM.0000000000000961
Original Research Articles
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Objective The aims of the study were to identify whether timing of venous thromboembolism diagnosis is associated with differences in patient outcomes and to perform a cost-effectiveness analysis of routine venous Doppler ultrasound at admission to inpatient rehabilitation, taking into account costs associated with prolonged inpatient rehabilitation length of stay, and development of pulmonary embolism.

Design This was a retrospective cohort study of 2312 consecutive patient discharges from a single inpatient rehabilitation facility for an 18-mo period. Cost-effectiveness model was built using TreeAge Healthcare Pro. The base case was constructed using probabilities and inpatient rehabilitation length of stay identified from retrospective analysis. Cost of Doppler ultrasound was obtained through the literature, and daily inpatient rehabilitation cost was obtained from the study institution.

Results Venous thromboembolism was diagnosed in 6.6% of patients. Asymptomatic patients diagnosed with venous thromboembolism on screening Doppler ultrasound had shorter inpatient rehabilitation length of stay (P = 0.045) and lower rate of pulmonary embolism (P < 0.001) and acute hospital transfer (P = 0.002) than those diagnosed after clinical symptoms developed. Use of routine Doppler ultrasound at inpatient rehabilitation admission was found to be cost-effective, with a total cost of US $20,265 per admission compared with $20,269 per admission without use of Doppler ultrasound at inpatient rehabilitation admission.

Conclusions Routine Doppler ultrasound screening for venous thromboembolism at inpatient rehabilitation admission is associated with improved patient outcomes without added cost per admission.

From the Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Charlotte, North Carolina (SMP); and Department of Medicine, Division of Infectious Disease (MY) and Department of Physical Medicine and Rehabilitation (GG), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

All correspondence should be addressed to: Shanti M. Pinto, MD, Carolinas Rehabilitation, 1100 Blythe Blvd, Charlotte, NC 28203.

This work was previously presented at Association of Academic Physiatrists Annual Meeting in Las Vegas, Nevada, on February 9, 2017.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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