Cost benefit of intermittent pneumatic compression for venous thromboembolism prophylaxis in general surgery.
OBJECTIVE
In moderate to high-risk general surgical patients, the cost effectiveness of mechanical prophylaxis for venous thromboembolism (VTE) is uncertain. Therefore, we determined the costs and savings of intermittent pneumatic compression (IPC) plus graduated compression stockings (GCS).


METHODS
Postoperative VTE events in the absence of prophylaxis, efficacy of prophylaxis and costs of prophylaxis have been obtained from the English literature and Medicare 2004 reimbursement schedule.


RESULTS
In 1000 moderate to high risk general surgical patients, in the absence of prophylaxis, the cost of investigating and treating 72 patients with clinical suspicion of DVT and 32 with PE is calculated to be $263,779. This corresponds to a cost of $263 per surgical patient. The cost of IPC combined with TED stockings in 1000 similar patients would be $66 760, and the cost of diagnosis and treatment of the reduced numbers (69% reduction) of clinical VTE is $ 83,574 making a total of $150 344. This means a saving of $133,435 ($263,779 - $150,344) per 1000 patients. This corresponds to a saving of $113 per surgical patient. Sensitivity analysis demonstrates that despite variation in costs or efficacy for IPC plus GCS, marked savings persist.


CONCLUSIONS
Prophylaxis with IPC not only prevents VTE but also saves money.
Nicolaides
A
A
Department of Vascular Surgery, Imperial College, London, UK. anicolai@cytanet.com.cy
Goldhaber
S Z
SZ
Maxwell
G L
GL
Labropoulos
N
N
Clarke-Pearson
D L
DL
Tyllis
T H
TH
Griffin
M B
MB
D000328:Adult; D000925:Anticoagulants / Q000191:economics; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D017721:Hospital Costs; D006801:Humans; D048228:Intermittent Pneumatic Compression Devices / Q000191:economics*; D008875:Middle Aged; D018803:Models, Economic; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D053828:Stockings, Compression / Q000191:economics; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000191:economics*; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex / Q000191:economics; D014481:United States; D054556:Venous Thromboembolism / Q000000981:diagnostic imaging / Q000191:economics* / Q000209:etiology / Q000517:prevention & control*
D000925:Anticoagulants