Money well spent? A cost and utilization analysis of prophylactic inferior vena cava filter placement in high-risk trauma patients

American Association for the Surgery of Trauma/American College of Surgeons-Committee on Trauma Clinical Protocol for inpatient venous thromboembolism prophylaxis after trauma

“…The use of IVCFs is associated with an increased risk of DVT and low retrieval rate without a reduction in PE or mortality. Costs associated with IVCFs are not inconsequential 68,69 . In rare instances in which a trauma patient is at extremely high risk of complication from VTE chemoprophylaxis for a prolonged period, the risks and benefits of IVCF placement must be considered 70 .…”

“…Costs associated with IVCFs are not inconsequential. 68,69 In rare instances in which a trauma patient is at extremely high risk of complication from VTE chemoprophylaxis for a prolonged period, the risks and benefits of IVCF placement must be considered. 70 If IVCF placement is performed, structured follow-up programs are needed to resume anticoagulation when safe, and to increase IVCF retrieval rates and detect complications.…”

Cost-effectiveness of early placement of vena cava filters to prevent symptomatic pulmonary embolism in patients with contraindications to prophylactic anticoagulant

“…We noted that there was one patient allocated to the control arm who died from PE confirmed by the post-mortem examination (0.9% vs 0% in the filter group, 95% CI: –2.3% to +4.6%). 8 Comparing this result with our threshold analysis – which showed that a 0.42% reduction in fatal PE would make the filter cost less than US$100,000 per LYG – would suggest that if the reduction in fatal PE rate in our trial can be confirmed by a larger size RCT (with 867 subjects per group to achieve 80% power to detect ⩾ 0.9% difference in fatal PE rates between the two groups), 19 this would have a dramatic positive impact on the cost-effectiveness of using vena cava filters as a primary means to prevent PE after major trauma. This is because many trauma patients are young; any preventable deaths averted by a vena cava filter could result in a substantial gain in many productive life-years, 20 making use of the vena cava filter to prevent PE cost-effective from a societal perspective.…”

“…8 Whether this strategy would significantly increase (or decrease) hospitalization cost, and whether it is cost-effective, remains uncertain. 19 The current economic analysis provides an important piece of information because the study design aimed to prospectively capture all components of healthcare costs of the study patients, including the costs of DVT, PE, transfusion for bleeding, anticoagulants, pathology tests, radiology imaging, personnel and procedures needed to insert and retrieve the filters, and managing the filter complications. Our results showed that using vena cava filters as a primary means to prevent symptomatic PE in major trauma patients who had contraindications to prophylactic anticoagulation after major trauma substantially increased the total hospitalization cost (USD $13,672 per patient).…”