Home Treatment of Pulmonary Embolism in the Era of Novel Oral Anticoagulants

Stein, Paul D.; Matta, Fadi; Hughes, Patrick G.; Hourmouzis, Zak N.; Hourmouzis, Nina P.; White, Robert L.; Ghiardi, Martina M.; Schwartz, Matthew A.; Moore, Hillary L.; Bach, Jennifer; Schweiss, Robert E.; Kazan, Viviane; Kakish, Edward; Keyes, Daniel C.; Hughes, Mary J.

doi:10.1016/j.amjmed.2016.03.035

Cited by 48 publications

(36 citation statements)

References 43 publications

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“…Treatment of those treated entirely at home was with novel oral anticoagulants in 4 (30.8%) of 13 patients, and in those discharged in 2 days, novel oral anticoagulants were prescribed only for 34 (28.6%) of 119 patients. 32 The oral factor Xa inhibitors rivaroxaban and apixaban were approved for the treatment of deep venous thrombosis and pulmonary embolism by the US Food and Drug Administration on November 2, 2012, and August 21, 2014, respectively. 33,34 Therefore, the impact, if any, of home treatment with these drugs would not be shown in our data.…”

Section: Discussionmentioning

confidence: 99%

National Trends in Home Treatment of Acute Pulmonary Embolism

Stein

Matta

Hughes

2016

Clin Appl Thromb Hemost

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Section: Discussionmentioning

confidence: 99%

National Trends in Home Treatment of Acute Pulmonary Embolism

Stein

Matta

Hughes

2016

Clin Appl Thromb Hemost

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“…Vinson et al 1 cite a number of previous studies that showed that outpatient pulmonary embolism management is low, 1% to 8%, at centers without defined clinical pathways or realtime clinical decision support. [6][7][8] Our own clinical experience with outpatient management of lower extremity deep venous thrombosis found that nearly all patients were admitted before the adoption of an institutional pathway and monthly compliance audits. 9 The American College of Chest Physicians and the British Thoracic Society, who first recommended outpatient pulmonary embolism management in 2003, advocate outpatient pulmonary embolism management for low-risk patients with adequate social circumstance.…”

Section: Discussion Pointsmentioning

confidence: 99%

Outpatient Pulmonary Embolism Management: If You Walk Into the Emergency Department With a Pulmonary Embolism, Maybe You Should Also Walk Out

Barrett

Freeman

2018

Annals of Emergency Medicine

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“…Unlike Canada and Europe, this is not the current management approach in the United States 23. With an increasing number of risk scoring algorithms developed, we hypothesize that this cost‐saving measure may soon see an increased use in the United States.…”

Section: Methodsmentioning

confidence: 99%

The Economic Value of Hybrid Single‐photon Emission Computed Tomography With Computed Tomography Imaging in Pulmonary Embolism Diagnosis

Toney

Kim

Palli

2017

Academic Emergency Medicine

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ObjectiveThe objective was to quantify the potential economic value of single‐photon emission computed tomography (SPECT) with computed tomography (CT; SPECT/CT) versus CT pulmonary angiography (CTPA), ventilation–perfusion (V/Q) planar scintigraphy, and V/Q SPECT imaging modalities for diagnosing suspected pulmonary embolism (PE) patients in an emergency setting.MethodsAn Excel‐based simulation model was developed to compare SPECT/CT versus the alternate scanning technologies from a payer's perspective. Clinical endpoints (diagnosis, treatment, complications, and mortality) and their corresponding cost data (2016 USD) were obtained by performing a best evidence review of the published literature. Studies were pooled and parameters were weighted by sample size. Outcomes measured included differences in 1) excess costs, 2) total costs, and 3) lives lost per annum between SPECT/CT and the other imaging modalities. One‐way (±25%) sensitivity and three scenario analyses were performed to gauge the robustness of the results.ResultsFor every 1,000 suspected PE patients undergoing imaging, expected annual economic burden by modality was found to be 3.2 million (SPECT/CT), 3.8 million (CTPA), 5.8 million (planar), and 3.6 million (SPECT) USD, with a switch to SPECT/CT technology yielding per‐patient‐per‐month cost savings of $51.80 (vs. CTPA), $213.80 (vs. planar), and $36.30 (vs. SPECT), respectively. The model calculated that the incremental number of lives saved with SPECT/CT was six (vs. CTPA) and three (vs. planar). Utilizing SPECT/CT as the initial imaging modality for workup of acute PE was also expected to save $994,777 (vs. CTPA), $2,852,014 (vs. planar), and $435,038 (vs. SPECT) in “potentially avoidable”’ excess costs per annum for a payer or health plan.ConclusionCompared to the currently available scanning technologies for diagnosing suspected PE, SPECT/CT appears to confer superior economic value, primarily via improved sensitivity and specificity and low nondiagnostic rates. In turn, the improved diagnostic accuracy accords this modality the lowest ratio of expenses attributable to potentially avoidable complications, misdiagnosis, and underdiagnosis.

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Home Treatment of Pulmonary Embolism in the Era of Novel Oral Anticoagulants

Cited by 48 publications

References 43 publications

National Trends in Home Treatment of Acute Pulmonary Embolism

National Trends in Home Treatment of Acute Pulmonary Embolism

Outpatient Pulmonary Embolism Management: If You Walk Into the Emergency Department With a Pulmonary Embolism, Maybe You Should Also Walk Out

The Economic Value of Hybrid Single‐photon Emission Computed Tomography With Computed Tomography Imaging in Pulmonary Embolism Diagnosis

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