Cost-effectiveness of early placement of vena cava filters to prevent symptomatic pulmonary embolism in patients with contraindications to prophylactic anticoagulant

Introduction: Vena cava filters have been used as a primary means to prevent symptomatic pulmonary embolism (PE) in trauma patients who cannot be anticoagulated after severe injury, but the economic implications for this practice remain unclear. Methods: Using a healthcare system perspective to analyze the a priori primary outcome of the da Vinci trial, we report the cost-effectiveness of using vena cava filters as a primary means to prevent PE in patients who have contraindications to prophylactic anticoagulation after major trauma. Results: Of the 240 patients enrolled, complete, prospectively collected, hospital cost data during the entire hospital stay − including costs for the filter, medical/nursing/allied health staff, medical supplies, pathology tests, and radiological imaging − were available in 223 patients (93%). Patients allocated to the filter group ( n = 114) were associated with a reduced risk of PE (0.9%) compared to those in the control group ( n = 109, 5.5%; p = 0.048); and the filter’s benefit was more pronounced among those who could not be anticoagulated within 7 days (filter: 0% vs control: 16%, Bonferroni-corrected p = 0.02). Overall, the cost needed to prevent one PE was high (AUD $379,760), but among those who could not be anticoagulated within 7 days, the costs to prevent one PE (AUD $36,156; ~ USD $26,032) and gain one quality-adjusted life-year (AUD $30,903; ~ USD $22,250) were substantially lower. Conclusion: The cost of using a vena cava filter to prevent PE for those who have contraindications to prophylactic anticoagulation within 3 days of injury is prohibitive, unless such contraindications remain for longer than 7 days. (Australian New Zealand Clinical Trials Registry no.: ACTRN12614000963628)

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Advanced Management Options for Massive and Submassive Pulmonary Embolism

US Cardiology Review ◽

10.15420/usc.2016.10.1.30 ◽

2016 ◽

Vol 10 (1) ◽

pp. 30 ◽

Cited By ~ 4

Author(s):

Sonika Malik ◽

◽

Anju Bhardwaj ◽

Matthew Eisen ◽

Sanjay Gandhi ◽

...

Keyword(s):

Pulmonary Embolism ◽

Vena Cava ◽

Right Ventricular Dysfunction ◽

Hemodynamic Instability ◽

Adverse Outcomes ◽

Intermediate Risk ◽

Management Options ◽

Vena Cava Filters ◽

Submassive Pulmonary Embolism ◽

Risk Patients

Pulmonary embolism (PE) is an important cause of morbidity and mortality and presents with significant diagnostic and therapeutic challenges. Clinical presentation ranges from mild, nonspecific symptoms to syncope, shock, and sudden death. Patients with hemodynamic instability and/ or signs of right ventricular dysfunction are at high risk for adverse outcomes and may benefit from aggressive therapy and support. Therapeutic anticoagulation is indicated in all patients in the absence of contraindications. Thrombolysis should be strongly considered in selected high- and intermediate-risk patients, either by systemic infusion or percutaneous catheter-directed therapy. Other therapeutic modalities, such as vena cava filters and surgical embolectomy, are options for patients who fail or cannot tolerate anticoagulation and/or thrombolysis. This article reviews the assessment and advanced management options for acute PE with focus on high- and intermediate-risk patients.

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Effect of inferior vena cava filters on pulmonary embolism-related mortality and major complications: a systematic review and meta-analysis of randomized controlled trials

Journal of Vascular Surgery Venous and Lymphatic Disorders ◽

10.1016/j.jvsv.2021.02.008 ◽

2021 ◽

Vol 9 (3) ◽

pp. 792-800.e2

Author(s):

Yang Liu ◽

Huan Lu ◽

Hualong Bai ◽

Qi Liu ◽

Rongchang Chen

Keyword(s):

Systematic Review ◽

Pulmonary Embolism ◽

Inferior Vena ◽

Meta Analysis ◽

Vena Cava ◽

Controlled Trials ◽

Randomized Controlled ◽

Inferior Vena Cava Filters ◽

Vena Cava Filters ◽

Related Mortality

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The cost-effectiveness of transcatheter aortic valve implantation: exploring the Italian National Health System perspective and different patient risk groups

The European Journal of Health Economics ◽

10.1007/s10198-021-01314-z ◽

2021 ◽

Author(s):

V. Lorenzoni ◽

G. Barbieri ◽

F. Saia ◽

F. Meucci ◽

G. L. Martinelli ◽

...

Keyword(s):

Cost Effectiveness ◽

Aortic Valve ◽

National Health System ◽

Risk Groups ◽

System Perspective ◽

Transcatheter Aortic Valve ◽

Life Years ◽

Italian National Health ◽

Valve Implantation ◽

The Cost

Abstract Objectives To assess the cost-effectiveness (CE) of transcatheter aortic valve implantation (TAVI) in Italy, considering patient groups with different surgical risk. Methods A Markov model with a 1-month cycle length, comprising eight different health states, defined by the New York Heart Association functional classes (NYHA I–IV), with and without stroke plus death, was used to estimate the CE of TAVI for intermediate-, high-risk and inoperable patients considering surgical aortic valve replacement or medical treatment as comparators according to the patient group. The Italian National Health System perspective and 15-year time horizon were considered. In the base-case analysis, effectiveness data were retrieved from published efficacy data and total direct costs (euros) were estimated from national tariffs. A scenario analysis considering a micro-costing approach to estimate procedural costs was also considered. The incremental cost-effectiveness ratio (ICER) was expressed both in terms of costs per life years gained (LYG) and costs per quality adjusted life years (QALY). All outcomes and costs were discounted at 3% per annum. Univariate and probabilistic sensitivity analyses (PSA) were performed to assess robustness of results. Results Over a 15-year time horizon, the higher acquisition costs for TAVI were partially offset in all risk groups because of its effectiveness and safety profile. ICERs were €8338/QALY, €11,209/QALY and €10,133/QALY, respectively, for intermediate-, high-risk and inoperable patients. ICER values were slightly higher in the scenario analysis. PSA suggested consistency of results. Conclusions TAVI would be considered cost-effective at frequently cited willingness-to-pay thresholds; further studies could clarify the CE of TAVI in real-life scenarios.

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PND29 Scenario Analyses on Major Impactful and Uncertain Inputs of the Cost-Effectiveness Model of Fremanezumab From a Healthcare System Perspective in England

Value in Health ◽

10.1016/j.jval.2021.04.813 ◽

2021 ◽

Vol 24 ◽

pp. S164

Author(s):

A. Skroumpelos ◽

M. Freddi ◽

H. Akcicek ◽

J. Cohen ◽

M.T. Driessen

Keyword(s):

Cost Effectiveness ◽

Healthcare System ◽

System Perspective ◽

Healthcare System Perspective ◽

Scenario Analyses ◽

Effectiveness Model ◽

The Cost

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Cost-Effectiveness of Hip Arthroscopy for Treatment of Femoroacetabular Impingement Syndrome and Labral Tears: A Systematic Review

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120987538 ◽

2021 ◽

Vol 9 (3) ◽

pp. 232596712098753

Author(s):

Cammille C. Go ◽

Cynthia Kyin ◽

Jeffrey W. Chen ◽

Benjamin G. Domb ◽

David R. Maldonado

Keyword(s):

Systematic Review ◽

Cost Effectiveness ◽

Femoroacetabular Impingement ◽

Hip Arthroscopy ◽

Nonoperative Treatment ◽

Cochrane Library ◽

System Perspective ◽

Labral Tears ◽

The Cost

Background: Hip arthroscopy has frequently been shown to produce successful outcomes as a treatment for femoroacetabular impingement (FAI) and labral tears. However, there is less literature on whether the favorable results of hip arthroscopy can justify the costs, especially when compared with a nonoperative treatment. Purpose: To systematically review the cost-effectiveness of hip arthroscopy for treating FAI and labral tears. Study Design: Systematic review; Level of evidence, 3. Methods: PubMed/MEDLINE, Embase, and Cochrane Library databases, and the Tufts University Cost-Effectiveness Analysis Registry were searched to identify articles that reported the cost per quality-adjusted life-year (QALY) generated by hip arthroscopy. The key terms used were “hip arthroscopy,” “cost,” “utility,” and “economic evaluation.” The threshold for cost-effectiveness was set at $50,000/QALY. The Methodological Index for Non-Randomized Studies instrument and Quality of Health Economic Studies (QHES) score were used to determine the quality of the studies. This study was prospectively registered on PROSPERO (CRD42020172991). Results: Six studies that reported the cost-effectiveness of hip arthroscopy were identified, and 5 of these studies compared hip arthroscopy to a nonoperative comparator. These studies were found to have a mean QHES score of 85.2 and a mean cohort age that ranged from 33-37 years. From both a health care system perspective and a societal perspective, 4 studies reported that hip arthroscopy was more costly but resulted in far greater gains than did nonoperative treatment. The preferred treatment strategy was most sensitive to duration of benefit, preoperative osteoarthritis, cost of the arthroscopy, and the improvement in QALYs with hip arthroscopy. Conclusion: In the majority of the studies, hip arthroscopy had a higher initial cost but provided greater gain in QALYs than did a nonoperative treatment. In certain cases, hip arthroscopy can be cost-effective given a long enough duration of benefit and appropriate patient selection. However, there is further need for literature to analyze willingness-to-pay thresholds.

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