Cost-effectiveness of ultrasound in preventing femoral venous catheter-associated pulmonary embolism

Am J Respir Crit Care Med. 2003 Dec 15;168(12):1481-7. doi: 10.1164/rccm.200303-367OC. Epub 2003 Jul 31.


Femoral central venous catheter use is complicated by a high risk of deep venous thrombosis despite antithrombotic prophylaxis. Although some have recommended screening for femoral catheter-associated thrombosis to prevent pulmonary embolism (PE), this strategy's economic implications are unclear. Therefore, we used a decision model to evaluate the potential cost-effectiveness of a Doppler ultrasound-based screening strategy versus no ultrasound in averting thromboembolic complications associated with femoral catheters. The base-case analysis included a hypothetical cohort of 60-year-old medical patients treated for acute respiratory failure. The perspective was that of the health care payor, and the primary outcomes were quality-adjusted life expectancy, PE, and PE-associated deaths. The ultrasound strategy cost $8,688/quality-adjusted life-year (QALY) gained, $5,305/PE averted, and $99,286/PE death averted. The best- and worst-case scenarios, calculated in multiway sensitivity analyses by varying in-hospital mortality, deep venous thrombosis prevalence, and ultrasound accuracy, ranged from $1,170/QALY to $35,342/QALY, respectively. Probablistic analyses, in which variables with uncertain values were varied randomly within their ranges, demonstrated median costs of $12,793/QALY (interquartile range $8,176/QALY, $20,648/QALY). In summary, ultrasound screening may improve outcomes among the critically ill with femoral venous catheters at acceptable costs and could complement venous thrombosis primary prevention programs.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Catheterization, Peripheral / adverse effects*
  • Cohort Studies
  • Cost-Benefit Analysis / economics
  • Cost-Benefit Analysis / methods
  • Decision Support Techniques*
  • Female
  • Femoral Vein / diagnostic imaging
  • Humans
  • Male
  • Middle Aged
  • Pulmonary Embolism / economics*
  • Pulmonary Embolism / etiology
  • Pulmonary Embolism / mortality
  • Pulmonary Embolism / prevention & control*
  • Quality-Adjusted Life Years
  • Ultrasonography / economics
  • Venous Thrombosis / diagnostic imaging*
  • Venous Thrombosis / economics
  • Venous Thrombosis / etiology
  • Venous Thrombosis / mortality