A study by Clifford W. Colwell, Jr., MD, Mark I. Froimson, MD, MBA, Michael A Mont, MD, Merrill A Ritter, MD, Robert Trousdale, MD, Knute C Buehler, MD, Andrew I. Spritzer, MD, Thomas K Donaldson, MD, Douglas E Padgett, MD.

Abstract

Recent comparison (SAFE study) of a mobile, synchronized compression device and low-molecular-weight heparin for prophylaxis of venous thromboembolism showed similar efficacy but significant differences in major bleeding. A model was constructed to evaluate any difference in cost-effectiveness between the 2 therapies incorporating rates and probabilities of major bleeding from the SAFE study with published costs for treating those adverse events. Evaluation of the cost-effectiveness of each therapy was performed and applied to hypothetical patient populations representative of annual health system volume. The model showed a cost- effectiveness advantage of the compression device resulting in a savings of more than $3.69 million in a 10 000-patient cohort. The result was primarily driven by a decrease in the amount of major bleeding, which requires significant health care resources to treat.

Results

The model assumptions included (1) that the rate of compliance was equivalent for both treatments and the patient outcomes in the SAFE study and other published references would be reproducible in clinical practice; (2) the length of therapy would be the same as described by Colwell et al [12] in the SAFE study for each therapy (10 days for compression and 10 days for LMWH); and (3) the dose of enoxaparin was the same as that used in the SAFE study and commonly used in the United States, specifically, 30 mg every 12 hours starting 12 to 24 hours postsurgery until discharge, then 40 mg once daily, for a total of 10 days. The cost total in the model included the probability and cost of the individual uncertain events of DVT, PE, and minor and major bleeding. The model showed that VTE prophylaxis with MCD would have an average cost advantage of $369.50 per patient (Figure). The cost differential in a hypothetical 1000-patient cohort would be $369 502, and in a 10 000-patient cohort, it would be $3 695 027. The difference in cost of therapy was primarily driven by the cost of major bleeding, which has a significantly greater probability when chemoprophylaxis was used. In the SAFE study, there were 11 of 194 cases of major bleeding in the enoxaparin group compared with 0 of 198 in the compression group (P = .0004). Major bleeding leads to extended hospital stays; increased physician, nursing, and pharmacy care; additional laboratory costs; and blood transfusions. In our analysis, the incremental cost to treat a major bleeding event was calculated to be $5363.13. Similarly, minor bleeding was slightly more prevalent in the chemoprophylaxis arm of the decision tree.

This study was published in The Journal of Arthroplasty.

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