Clinical StudiesEchocardiography in patients with suspected endocarditis: a cost-effectiveness analysis☆
Section snippets
Decision model
We developed a decision model using EXCEL (Version 5.0, Microsoft Corporation, Redmond, Washington) and DATA (Version 3.0, TreeAge Software, Boston, Massachusetts) software. The model compares six strategies for the diagnosis of endocarditis Figure 1, Figure 2. It consists of a decision tree that represents the immediate consequences for patients with suspected endocarditis, and a four-state Markov model 16, 17 to evaluate long-term survival. In the first strategy (bacteremia treatment), no
Results
For our base-case analysis of a 45-year-old man with a 20% prior probability of endocarditis, use of transesophageal echocardiography, either alone or after transthoracic echocardiography, provided the greatest quality-adjusted life expectancy (Table 4). Both of these strategies provided 9 additional quality-adjusted days of life compared with using a transthoracic study alone to determine treatment. Compared with the use of transesophageal echocardiography alone, treatment of all patients for
Discussion
We evaluated the cost-effectiveness of several diagnostic strategies for a patient with suspected endocarditis. Our base-case analysis (a 45-year-old patient with unexplained bacteremia) indicates that the use of transesophageal echocardiography alone provides the greatest QALYs at the lowest cost when compared with the use of a transthoracic study alone, use of a transthoracic study first followed by a transesophageal study if the initial study is negative, or treatment for endocarditis
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Endocarditis: The Role of Echocardiography in Diagnosis and Clinical Decision-Making
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Drs. Owens and Heidenreich were supported by career development awards from the Veterans Affairs Health Services Research and Development Service.