[Aspects of cost effectiveness in therapy of acute leg/pelvic vein thrombosis].

Out-patient or home treatment of acute proximal deep venous thrombosis (DVT) has not made its way yet. In this article, we review the data published on this form of management with regard to effectiveness and costs. We find that more than 80% of patients with DVT need not be admitted to the hospital and that the rate of secondary hospitalization is < 2%. Home treatment requires professional assistance in 15 to 74% of cases, while out-patient management with elastic leg compression and deliberate ambulation goes completely without it. The effect on objectivity assessed clinical symptoms, absence from work and patients' acceptance is significantly better and the costs are 2.5- to 3.2-fold lower with home or outpatient treatment than with treatment in the hospital. However, we found outpatient treatment associated with a reduced general well-being resulting from a probably frightening information which mentioned the possibility of experiencing an eventually fatal pulmonary embolism despite treatment. Management with deliberate ambulation in compression hosiery lead to a slower relief of subjective leg symptoms than initial immobilisation. We conclude that outpatient treatment of DVT is highly cost-effective. The problems still encountered are of a psychological nature and also have to do with treatment by leg compression and ambulation. These measures have to be optimized.