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

Abstract

BackgroundVenous 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.MethodsA 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.ResultsFor 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.ConclusionIPC 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.

A comparative cost-effectiveness analysis of mechanical and pharmacological VTE prophylaxis after lower limb arthroplasty in Australia

“…A previously published cost-utility model specific to hip and knee arthroplasty was extended to consider short-term (1 year) health and economic outcomes associated with all the major available types of prophylaxis [17]. The published semi-Markov model was informed by a structured literature review to identify data related to THA and TKA, secondary outcomes and prophylaxis regimens.…”

“…The published semi-Markov model was informed by a structured literature review to identify data related to THA and TKA, secondary outcomes and prophylaxis regimens. The following secondary safety outcomes were identified and accounted for pulmonary embolism (PE), DVT, post-thrombotic syndrome (PTS), heparin-induced thrombocytopenia (HIT), major and minor bleeding and intracranial haemorrhage (ICH) [17]. All patients started in post-surgical ‘No VTE’ state and received prophylaxis for 30 days.…”

A comparison of different modes of pneumatic compression on muscle tissue oxygenation: An intraparticipant, randomised, controlled volunteer study

“…28 In addition, the sequential compressions device customizes the compression cycle time by sensing the venous filling time and this may allow more venous compressions than the single-compartment device (which has a fixed cycling time of one minute) over the same period of time. Although IPC has a reasonably strong evidence base in reducing DVT and PE in a variety of hospitalised patients−either alone or in combination with anticoagulant prophylaxis−especially for patients at high risk of VTE, 15,16,37,38 there is no high-level RCT evidence to suggest that a sequential compressions IPC device is more efficacious than a single-compartment device in reducing DVT/PE. 39 Because StO 2 in the lower limbs had previously been demonstrated to correlate positively with regional blood flow measured by an ultrasound Doppler, 34 our results provide some rationale to support testing the hypothesis that a sequential compressions mode IPC is better than a single-compartment mode IPC in improving venous leg ulcers healing in patients with chronic leg ulcers 40 and reducing lower limb DVT.…”

Anticoagulant activity of enoxaparin and unfractionated heparin for venous thromboembolism prophylaxis in obese patients undergoing sleeve gastrectomy

“…Additional considerations when interpreting findings concerning VTE chemoprophylaxis dosing are the use intermittent pneumatic compression therapy systems, as well as postoperative time to ambulation. Several studies have indicated the benefit of implementing intermittent pneumatic compression (IPCs) as a standard for VTE mechanical prophylaxis, and as such, can be a confounding factor that reduces incidence of VTE [44,45] . Likewise, a decrease in time to ambulation postoperatively has been shown to decrease incidence of VTE [46] .…”