Abstract
BackgroundVenous 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.MethodsAll 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.Results4234 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.ConclusionsSurveillance 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.
Highlights
Venous thrombo-embolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE) causes significant morbidity and mortality among traumatized patients
The current study evaluates the cost effectiveness of such a surveillance program on traumatized patients at high risk of VTE, with a particular focus on the quality adjusted life years (QALY) gained from any reduction in PE
There were 4234 trauma patients admitted to the intensive care unit (ICU) during the 84-month study period (Table 1)
Summary
Venous thrombo-embolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE) causes significant morbidity and mortality among traumatized patients. Patients that do develop DVT are at risk of short term complications (limb threatening phlegmasia, and life threatening PE) and long term complications (post-phlebetic limb, and pulmonary hypertension). [10,11] Surveillance screening for DVT in high risk patients may be an effective strategy to diagnose and treat DVT and reduce both short and long term morbidity and mortality. The current study evaluates the cost effectiveness of such a surveillance program on traumatized patients at high risk of VTE, with a particular focus on the quality adjusted life years (QALY) gained from any reduction in PE. 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
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