title: Inferior vena cava filter retrieval provides no advantage in the average patient.
abstract: BACKGROUND
  Inferior vena cava (IVC) filter placement is performed to mitigate the risk of pulmonary embolism (PE) when anticoagulation is contraindicated or ineffective. Technical advances now allow catheter-based filter retrieval. Many believe the benefits of retrieval are self-evident, yet retrieval carries an inherent complication risk and cost. The purpose of this study was to quantitatively weigh the risks and benefits of IVC filter retrieval using formal decision analysis.
  
  
  METHODS
  A Markov state-transition model was used to simulate two clinical scenarios: to leave a previously placed IVC filter or to retrieve it. Analysis was performed during the lifetime of the individual, and outcomes were expressed in quality-adjusted life-years (QALYs). The base case is a 60-year-old man with a filter placed within 3 months who no longer requires mechanical thromboprophylaxis. Potential events included PE, filter complications, and death from all other causes during each cycle. Tolls were used to incorporate the disutility of short-term treatment for PE and filter complications. For the base case and sensitivity analyses, we used utilities and probabilities derived from the literature.
  
  
  RESULTS
  In the base case scenario, leaving the filter in place was preferred to filter retrieval, yielding 22.3 vs 21.9 QALYs. One-way sensitivity analysis demonstrated that filter retrieval may be preferable if the utility of living with a filter is <0.98. For all probabilities of retrieval and PE mortality, leaving the filter in place is preferred.
  
  
  CONCLUSIONS
  Leaving a previously placed IVC filter provides a 0.4 QALY benefit over retrieving the filter for the average patient. This decision is sensitive to the utility of living with the IVC filter.
authors.affiliation: Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH. Electronic address: courtney.j.warner@hitchcock.org.
authors.forename: Courtney J
authors.initials: CJ
authors.lastname: Warner
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Richey
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.
authors.forename: Dyane E
authors.initials: DE
authors.lastname: Tower
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.
authors.forename: Anna E
authors.initials: AE
authors.lastname: Condino
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Tapp
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
authors.affiliation: Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Walsh
mesh_terms: D003365:Costs and Cost Analysis; D020878:Device Removal / Q000009:adverse effects / Q000191:economics; D006801:Humans; D008297:Male; D011655:Pulmonary Embolism / Q000503:physiopathology / Q000517:prevention & control; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D016896:Treatment Outcome; D016306:Vena Cava Filters / Q000009:adverse effects / Q000191:economics; D014682:Vena Cava, Inferior / Q000473:pathology; D020246:Venous Thrombosis / Q000628:therapy