Introduction
pulmonary embolism, Pulmonary embolism, VTE, venous thromboembolism
PULMONARY EMBOLISM, PULMONARY EMBOLISM
Pulmonary embolism (PE) and venous thromboembolism (VTE) are an important health and economic burden, with estimated direct and indirect costs of about 10,000€ per confirmed case of PE, and the loss of over one healthy year in Europe [The optimal diagnostic strategy for patients with suspected pulmonary embolism remains under debate. The usual diagnostic strategy implemented consists of initially estimating the prior probability from clinical information, followed by a D-dimer test (in patients with a low clinical probability), and, if the D-dimer level is above a certain threshold, chest imaging (computed tomography pulmonary angiography [CTPA] or pulmonary ventilation/perfusion scintigraphy [V/Q scan]). This strategy presents with an approximate diagnostic yield of 10% [In order to safely reduce the use of CTPA in emergency departments (ED) and the additional costs involved, a modified diagnostic strategy, which combines the YEARS rule (clinical criteria that elevates the D-dimer threshold for prescribing CPTA) with the pulmonary embolism rule-out criteria (PERC) rule and the age-adjusted D-dimer threshold was tested in the MODIGLIA-NI study [In this study, we estimated the cost-effectiveness of the YEARS rule and age-adjusted D-dimer threshold (intervention) compared with age-adjusted D-dimer threshold (control). This economic evaluation was conducted alongside the trial with three-months of follow-up.