Cost of VTE
It is more cost-effective to prevent a VTE than to treat it.
It remains to be determined whether the routine use of extended-duration thromboprophylaxis is cost-effective, although it seems likely that
The additional costs associated with extended therapy would be acceptable when compared with the costs of treating postoperative venous thromboembolism.
This study suggests that extending thromboprophylaxis with low molecular weight heparin for approximately three weeks after hospital discharge is cost-effective.
The cost to treat VTE after TKA/THA is $46,709 (derived from CMS and sources within their Federal Register and CMS).
Approximate Risks of DVT in Hospitalized Patients
Rates based on objective diagnostic screening or asymptomatic DVT in patients not receiving thromboprophylaxis. DVT Prevalence, percentages: Medical patients 10-20%, General surgery 15-40%, Major gynecologic surgery 15-40%, Major urologic surgery 15-40%, Neurosurgery 15-40%, Stroke 20-50%, Hip or knee arthroplasty 40-60%, Major trauma 40-80%, SCI 60-80%, Critical care patients 10-80%.
ADVERSE CONSEQUENCES OF UNPREVENTED DVT
- Symptomatic DVT and PE
- Fatal PE
- Thromboprophylaxis is highly effective at preventing symptomatic VTE and fatal PE
- Risks and costs of treating unprevented VTE
- Increased future risk of recurrent VTE
- Chronic postthrombotic syndrome
- Efficacy and effectiveness of thromboprophylaxis
- Costs of investigating symptomatic patients
- The prevention of DVT also prevents PE
- Cost-effectiveness of thromboprophylaxis has repeatedly been demonstrated
Geerts, William H.; Bergqvist, David; Pineo, Graham F.; Heit, John A.; Samama, Charles M.; Lassen, Michael R.; Colwell, Clifford W.; (2008). “Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th Edition). Chest 133; 381S-453S
Rationale for Thromboprophylaxis in Hospitalized Patients
High prevalence of VTE
Almost all hospitalized patients have one or more risk factors for VTE
DVT is common in many hospitalized patient groups
Hospital-acquired DVT and PE are usually clinically silent
It is difficult to predict which at-risk patients will develop symptomatic thromboembolic complications
Screening at-risk patients using physical examination or noninvasive testing is neither cost-effective nor effective
Mechanical prophylaxis is more cost-effective than pharmacological prophylaxis in preventing DVT
Although low-molecular-weight heparin and unfractionated heparin were cost-effective compared with no prophylaxis, each was less effective than the external pneumatic compression in the base case. External pneumatic compression appears to be the most cost-effective strategy under our baseline assumptions, but further studies in gynecologic cancer are needed to validate our conclusions. Maxwell, G. Larry, MD; Myers, Evan R. MD; Clarke-Pearson, Daniel L. MD. (2000}. “Cost-effectiveness of deep venous thrombosis prophylaxis in gynecologic oncology surgery: Obstetrics & Gynecology. 95, 206214
The duration of anticoagulant thromboprophylaxis after hip or knee replacement depends on individual patient risks. Because of the costs and inconvenience of administering extended-duration anticoagulant prophylaxis to all patients who undergo hip or knee replacement, it may be reasonable to limit extended-duration prophylaxis to high-risk groups. Douketis, James MD. (2003). “In Consultation-Preventing DVT: Is short-duration prophylaxis effective?
The Journal of Critical Illness.