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Intermittent pneumatic compression is a cost-effective method of orthopedic postsurgical venous thromboembolism prophylaxis

Authors Saunders R, Comerota AJ, Ozols A, Torrejon Torres R, Ho KM

Received 17 November 2017

Accepted for publication 23 February 2018

Published 19 April 2018 Volume 2018:10 Pages 231—241


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Ms Justinn Cochran

Peer reviewer comments 2

Editor who approved publication: Professor Dean Smith

Rhodri Saunders,1 Anthony J Comerota,2 Audrey Ozols,3 Rafael Torrejon Torres,1 Kwok Ming Ho4

1Coreva Scientific, Freiburg, Germany; 2Jobst Vascular Institute, Toledo, OH, USA; 3Medtronic, Boulder, CO, USA; 4Royal Perth Hospital and School of Population Health, University of Western Australia, Perth, WA, Australia

Background: Venous thromboembolism (VTE) is a major complication after lower-limb arthroplasty that increases costs and reduces patient’s quality of life. Using anticoagulants for 10–35 days following arthroplasty is the standard prophylaxis, but its cost-effectiveness after accounting for bleeding complications remains unproven.
Methods: A comprehensive, clinical model of VTE was created using the incidences, clinical effects (including bleeding), and costs of VTE and prophylaxis from randomized controlled trials, meta-analyses, and large observational studies. Over 50 years, the total health care costs and clinical impact of three prophylaxis strategies, that are as follows, were compared: low-molecular-weight heparin (LMWH) alone, intermittent pneumatic compression (IPC), and IPC with LMWH (IPC+LMWH). The cost per VTE event that was avoided and cost per quality-adjusted life year (QALY) gained in both the US and Australian health care settings were calculated.
Results: For every 2,000 patients, the expected number of VTE and major bleeding events with LMWH were 151 and 6 in the USA and 160 and 46 in Australia, resulting in a mean of 11.3 and 9.1 QALYs per patient, respectively. IPC reduced the expected VTE events by 11 and 8 in the USA and Australia, respectively, compared to using LMWH alone. IPC reduced major bleeding events compared to LMWH, preventing 1 event in the US and 7 in Australia. IPC+LMWH only reduced VTE events. Neither intervention substantially impacted QALYs but both increased QALYs versus LMWH. IPC was cost-effective followed by IPC+LMWH.
Conclusion: IPC and IPC+LMWH are cost-effective versus LMWH after lower-limb arthroplasty in the USA and Australia. The choice between IPC and IPC+LMWH depends on expected bleeding risks.

Keywords: VTE, IPC, thromboprophylaxis, arthroplasty, mechanical prophylaxis, cost-effectiveness

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