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Poster Networking

Venous Thromboembolism

PB0920 - Cost-effectiveness of follow-up algorithms for chronic thromboembolic pulmonary hypertension in pulmonary embolism survivors

Monday, June 24, 2024
13:45 – 14:45 ICT
Room: Exhibition Hall

    Presenting Author(s)

  • Dieuwke Luijten, MD, PhD cadidate

    Department of Medicine - Thrombosis & Hemostasis, Leiden University Medical Center
    Leiden, Zuid-Holland, Netherlands

    • Co-Author(s)

  • Wv

    Wilbert B. van den Hout

    PhD, prof
    Department of Biomedical Data Science - Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
    Leiden, Zuid-Holland, Netherlands

  • GB

    Gudula J.A.M. Boon

    MD, PhD
    Department of Medicine - Thrombosis & Hemostasis, Leiden University Medical Center
    Leiden, Zuid-Holland, Netherlands

  • Stefano Barco

    MD, PhD
    Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
    Zurich, Zurich, Switzerland

  • HB

    Harm Jan Boogaard

    MD, PhD, prof
    Department of Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
    Amsterdam, Noord-Holland, Netherlands

  • MD

    Marion Delcroix

    MD, PhD, prof
    Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
    Leuven, Vlaams-Brabant, Belgium

  • KK

    Karl-Friedrich Kreitner

    MD, PhD
    Department of Radiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
    Mainz, Rheinland-Pfalz, Germany

  • MH

    Matthias Held

    MD, PhD
    Medizinische Klinik mit Schwerpunkt Pneumologie und Beatmungsmedizin, Missioklinik Klinikum Würzburg Mitte, Würzburg, Germany
    Würzburg, Bayern, Germany

  • MH

    Menno V. Huisman

    Professor of Medicine
    Department of Medicine – Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands; Dutch Thrombosis Network, The Netherlands.
    Leiden, Zuid-Holland, Netherlands

  • LJ

    Luis Jara-Palomares

    MD, PhD
    Respiratory Department, Virgen del Rocío Hospital and Instituto de Biomedicina, Sevilla
    Sevilla, Andalucia, Spain

  • SK

    Stavros Konstantinides

    MD, PhD, prof
    Center for Thrombosis and Hemostasis (CTH), University Medical Centre of the Johannes Gutenberg University, Mainz, Germany.
    Mainz, Rheinland-Pfalz, Germany

  • LK

    Lucia J.M. Kroft

    MD, PhD
    Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
    Leiden, Zuid-Holland, Netherlands

  • AM

    Albert T.A. Mairuhu

    MD, PhD
    Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
    the Hague, Zuid-Holland, Netherlands

  • LM

    Lilian J. Meijboom

    MD, PhD
    Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
    Amsterdam, Noord-Holland, Netherlands

  • Tv

    Thijs E. van Mens

    MD, PhD
    Department of Medicine - Thrombosis & Hemostasis, Leiden University Medical Center
    Leiden, Zuid-Holland, Netherlands

  • MN

    Maarten K. Ninaber

    MD, PhD
    Department of pulmonology, Leiden University Medical Center, Leiden, The Netherlands
    Leiden, Zuid-Holland, Netherlands

  • EN

    Esther J. Nossent

    MD, PhD
    Department of Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
    Amsterdam, Noord-Holland, Netherlands

  • LV

    Luca Valerio

    MD, PhD
    Department of Cardiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
    Mainz, Rheinland-Pfalz, Germany

  • AV

    Anton Vonk Noordegraaf

    MD, PhD, prof
    Department of Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
    Amsterdam, Noord-Holland, Netherlands

  • Erik Klok, MD, PhD, FESC

    Leiden University Medical Center

Background: Achieving an early diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) in pulmonary embolism (PE) survivors results in better quality of life and survival. Importantly, dedicated follow-up strategies to establish earlier CTEPH diagnosis involve costs that were not explicitly incorporated in the models assessing their cost-effectiveness.

Aims: We performed an economic evaluation of 11 distinct PE follow-up algorithms to determine which should be preferred.

Methods: 11 different PE follow-up algorithms (figure 1) and 1 hypothetical scenario without a dedicated CTEPH follow-up algorithm were included in a Markov model. Diagnostic accuracy of consecutive tests was estimated from patient-level data of the InShape II study (n=424). The life-long costs per CTEPH patient were compared and related to Quality-Adjusted Life-Years (QALYs) for each scenario.

Results: Compared to not performing a dedicated follow-up, any integrated follow-up algorithm is associated with an estimated increase of 0.89-1.15 QALY against an incremental cost-effectiveness ratio (ICER) of 25.900-46.300 €/QALY per CTEPH patient, as per current Dutch standards (figure 2). When comparing different algorithms there was a maximum difference of 0.27 QALY and €22.300. The most cost-effective algorithm was the InShape IV algorithm (a modified version of InShape II with incorporated computed tomography pulmonary angiography assessment of index PE), with an ICER of €26,700 per QALY compared to the next best algorithm.

Conclusion(s): Subjecting all PE survivors to any of the currently established dedicated follow-up algorithm to detect CTEPH is cost-effective and preferred above not performing a dedicated follow-up, as they all remained under the Dutch acceptability threshold of €50,000/QALY. The comparison of different algorithms presented in this study can be used to identify a locally preferred algorithm to incorporate in daily practice from an economical point-of-view within local logistical possibilities.