title: DVT surveillance program in the ICU: analysis of cost-effectiveness.
abstract: BACKGROUND
  Venous 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.
  
  
  METHODS
  All 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.
  
  
  RESULTS
  4234 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.
  
  
  CONCLUSIONS
  Surveillance 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.
authors.affiliation: Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, United States of America.
authors.forename: Ajai K
authors.initials: AK
authors.lastname: Malhotra
authors.affiliation: Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, United States of America.
authors.forename: Stephanie R
authors.initials: SR
authors.lastname: Goldberg
authors.affiliation: Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, United States of America.
authors.forename: Laura
authors.initials: L
authors.lastname: McLay
authors.affiliation: Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, United States of America.
authors.forename: Nancy R
authors.initials: NR
authors.lastname: Martin
authors.affiliation: Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, United States of America.
authors.forename: Luke G
authors.initials: LG
authors.lastname: Wolfe
authors.affiliation: Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, United States of America.
authors.forename: Mark M
authors.initials: MM
authors.lastname: Levy
authors.affiliation: Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, United States of America.
authors.forename: Vishal
authors.initials: V
authors.lastname: Khiatani
authors.affiliation: Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, United States of America.
authors.forename: Todd C
authors.initials: TC
authors.lastname: Borchers
authors.affiliation: Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, United States of America.
authors.forename: Therese M
authors.initials: TM
authors.lastname: Duane
authors.affiliation: Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, United States of America.
authors.forename: Michel B
authors.initials: MB
authors.lastname: Aboutanos
authors.affiliation: Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, United States of America.
authors.forename: Rao R
authors.initials: RR
authors.lastname: Ivatury
mesh_terms: D000328:Adult; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000191:economics*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000401:mortality / Q000517:prevention & control*; D016019:Survival Analysis; D014193:Trauma Centers; D016896:Treatment Outcome; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000191:economics* / Q000401:mortality