Cost-effective prevention of pulmonary embolus in high-risk trauma patients.
OBJECTIVE
To define the cost-effectiveness of screening ultrasound (US) and prophylactic inferior vena cava filters (VCF), approaches aimed at reducing the incidence of pulmonary embolus (PE) in high-risk trauma patients.


METHODS
Cost-effective analysis.


METHODS
We constructed a decision tree with three approaches for PE prevention: no intervention, US, and VCF. Probabilities in each subtree were taken from published data. Sensitivity analyses evaluated all assumptions, probabilities, and outcomes for effects on baseline conclusions.


RESULTS
US is more cost-effective than VCF, with a cost/PE prevented of $46,300 compared with $93,700. The strategies become equally cost-effective only when VCF are placed in the radiology suite and length of stay is > or = 2 weeks.


CONCLUSIONS
US is the most cost-effective approach for PE prevention in high-risk trauma patients. VCF should be reserved for patients with an anticipated length of stay > or = 2 weeks who can safely have a filter placed in the radiology suite.
Brasel
K J
KJ
Department of Surgery, St. Paul-Ramsey Medical Center, St. Paul, Minnesota 55101, USA.
Borgstrom
D C
DC
Weigelt
J A
JA
D000368:Aged; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005676:Gravity Suits / Q000191:economics; D006493:Heparin / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000191:economics* / Q000209:etiology / Q000517:prevention & control*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013927:Thrombosis / Q000000981:diagnostic imaging; D014463:Ultrasonography / Q000191:economics; D016306:Vena Cava Filters / Q000191:economics*; D014947:Wounds and Injuries / Q000150:complications*
D006493:Heparin