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Cost effectiveness of the addition of a comprehensive CT scan to the abdomen and pelvis for the detection of cancer after unprovoked venous thromboembolism

  • Kathryn Coyle
    Affiliations
    Brunel University, Uxbridge, Middlesex, United Kingdom, Kingston Ln, Uxbridge UB8 3PH, United Kingdom
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  • Marc Carrier
    Correspondence
    Corresponding author at: The Ottawa Hospital, General Campus, 501 Smyth Rd., Box 201a, Ottawa, ON K1H 8L6, Canada.
    Affiliations
    University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada

    Ottawa Hospital Research Institute, Ottawa Hospital, 725 Parkdale Avenue, Ottawa, ON K1Y 4E9, Canada
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  • Alejandro Lazo-Langner
    Affiliations
    Department of Medicine, University of Western Ontario, 1151 Richmond St, London, ON N6A 3K7, Canada

    Department of Epidemiology and Biostatistics, University of Western Ontario, 1151 Richmond St, London, ON N6A 3K7, Canada
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  • Sudeep Shivakumar
    Affiliations
    Department of Hematology, Queen Elizabeth II Health Sciences Centre, 1V8, 5805 South St, Halifax, NS B3H, Canada

    Department of Medicine, Dalhousie University, 6299 South St, Halifax, NS B3H 4R2, Canada
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  • Ryan Zarychanski
    Affiliations
    Department of Medicine, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB R3T 2N2, Canada

    Department of Hematology and Medical Oncology, Cancercare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
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  • Vicky Tagalakis
    Affiliations
    Department of Medicine, Sir Mortimer B. Davis Jewish General Hospital, 3755 Côte-Ste-Catherine Road, Montréal, QC H3T 1E2, Canada

    Center for Clinical Epidemiology, Lady Davis Institute, 3755 Chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1E2, Canada
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  • Susan Solymoss
    Affiliations
    Department of Medicine, McGill University, 845 Rue Sherbrooke O, Montréal, QC H3A 0G4, Canada

    Division of Hematology, Montreal General Hospital, 1650 Avenue Cedar, Montréal, QC H3G, Canada

    St. Mary's Hospital, 3830 Lacombe Avenue, Montréal, QC H3T 1M5, Canada
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  • Nathalie Routhier
    Affiliations
    Department of Medicine, Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC H3T 1J4, Canada

    Sacre Coeur Hospital, 5400 Boul Gouin O, Montréal, QC H4J 1C5, Canada
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  • James Douketis
    Affiliations
    St. Joseph's Healthcare Hamilton, 50 Charlton Ave. E., Hamilton, Ontario L8N 4A6, Canada

    Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
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  • Douglas Coyle
    Affiliations
    Brunel University, Uxbridge, Middlesex, United Kingdom, Kingston Ln, Uxbridge UB8 3PH, United Kingdom

    University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada

    Ottawa Hospital Research Institute, Ottawa Hospital, 725 Parkdale Avenue, Ottawa, ON K1Y 4E9, Canada
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      Highlights

      • Cost effectiveness of comprehensive CT scan for cancer detection after unprovoked VTE is assessed.
      • Comprehensive CT screening was more costly than limited screening alone.
      • CT screening was not more effective in improving quality of life or detecting occult cancers.
      • Implementing comprehensive CT screening after unprovoked VTE was not found to be cost effective.

      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.

      Abbreviations:

      VTE (venous thromboembolism), CT (comprehensive computed tomography)

      Keywords

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