DVT Surveillance Program in the ICU: Analysis of Cost-Effectiveness |
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Authors: | Ajai K. Malhotra Stephanie R. Goldberg Laura McLay Nancy R. Martin Luke G. Wolfe Mark M. Levy Vishal Khiatani Todd C. Borchers Therese M. Duane Michel B. Aboutanos Rao R. Ivatury |
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Affiliation: | 1. Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, United States of America.; 2. Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, United States of America.; The National Institute for Health Innovation, New Zealand, |
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Abstract: | BackgroundVenous Thrombo-embolism (VTE – Deep venous thrombosis (DVT) and/or pulmonary embolism (PE) – in traumatized patients causes significant morbidity and mortality. The current study evaluates the effectiveness of DVT surveillance in reducing PE, and performs a cost-effectiveness analysis.MethodsAll traumatized patients admitted to the adult ICU underwent twice weekly DVT surveillance by bilateral lower extremity venous Duplex examination (48-month surveillance period – SP). The rates of DVT and PE were recorded and compared to the rates observed in the 36-month pre-surveillance period (PSP). All patients in both periods received mechanical and pharmacologic prophylaxis unless contraindicated. Total costs – diagnostic, therapeutic and surveillance – for both periods were recorded and the incremental cost for each Quality Adjusted Life Year (QALY) gained was calculated.Results4234 patients were eligible (PSP – 1422 and SP – 2812). Rate of DVT in SP (2.8%) was significantly higher than in PSP (1.3%) – p<0.05, and rate of PE in SP (0.7%) was significantly lower than that in PSP (1.5%) – p<0.05. Logistic regression demonstrated that surveillance was an independent predictor of increased DVT detection (OR: 2.53 – CI: 1.462–4.378) and decreased PE incidence (OR: 0.487 – CI: 0.262–0.904). The incremental cost was $509,091/life saved in the base case, translating to $29,102/QALY gained. A sensitivity analysis over four of the parameters used in the model indicated that the incremental cost ranged from $18,661 to $48,821/QALY gained.ConclusionsSurveillance of traumatized ICU patients increases DVT detection and reduces PE incidence. Costs in terms of QALY gained compares favorably with other interventions accepted by society. |
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