I read with interest the recent article "Cost-effectiveness of Pulmonary Embolism Diagnosis" by Hull et al.1 The authors claim that a strategy using serial impedance plethysmography in patients with non-diagnostic lung scans and adequate cardiopulmonary reserve is the most cost-effective approach to the diagnosis and management of suspected pulmonary embolism. Their approach may actually be even less costly than they report, if the strategy is sufficiently supported by validating data documenting effectiveness.
In their cost calculations, Hull and colleagues include expenses for 5 serial noninvasive lower extremity studies. While 5 leg tests were performed in their initial 1989 study of this strategy,2 the findings of a more recent investigation involving patients with suspected deep vein thrombosis suggested that a total of 3 examinations yields similar results.3 If this theory is true, the proposed approach would save an additional $300 to $600 per patient.
The cost savings projected