Cost-Effectiveness of Universal vs. Selective CT Angiography in Stable Patients at High Risk for PE

In the evaluation of pulmonary embolism (PE), computed tomography angiography (CTA) has become the first-line imaging study. However, pulmonary CTA is associated with risk for contrast-induced nephropathy, contrast allergy, and radiation exposure. These authors conducted a decision analysis to evaluate the cost-effectiveness of two testing strategies — universal CTA and selective CTA — in a hypothetical, hemodynamically stable middle-aged woman with a high pretest likelihood of PE.

In the universal-CTA strategy, the initial test was CTA and the patient was treated for PE if results were positive. In the selective-CTA strategy, the initial test was lower-extremity compression ultrasound and the patient was treated for PE if results were posit…