Clinical and economic impact of compression in the acute phase of deep vein thrombosis

Unlabelled Box •The value of compression therapy in acute phase of deep vein thrombosis is still unclear. •Patients with deep vein thrombosis received acute compression hosiery, bandaging, or none. •Acute compression reduces irreversible skin signs related to post thrombotic syndrome. •Compression hosiery may be the preferred choice for the acute phase This study was funded by ZonMw (grant number 171102007), the Netherlands organization for Health Research and Development, which is a government organization promoting research into the cost‐effectiveness of medical treatments. There was no involvement of ZonMw in the conduct of the study, analysis, or writing of the manuscript. For this study, no separate ethical approval was needed or acquired, but data from the IDEAL study were used. For the IDEAL study, ethical approval was obtained from the Institutional Review Board of Maastricht University Medical Center (NL 32073.068.10), and was acknowledged by the ethical review boards of the participating centers. All participants gave written informed consent before any study‐related activity was performed. The lead author affirms that the manuscript is an honest, accurate and transparent account of the study being reported, that no important aspects of the study have been omitted, and that any discrepancies from the study as planned (and, if relevant, registered) have been explained. ZonMw 171102007 Summary: Background The effectiveness of compression therapy in the acute phase of deep vein thrombosis (DVT) is not yet determined. Objectives To investigate the impact of compression therapy in the acute phase of DVT on determinants of the Villalta score, health‐related quality of life (HRQOL), and costs. Patients/Methods Eight hundred and sixty‐five patients with proximal DVT (substudy of the IDEAL DVT study) received, immediately after DVT diagnosis, either no compression, multilayer bandaging, or hosiery. In the acute phase and 3 months after diagnosis, HRQOL was determined by use of the EQ‐5D, SF6D, and VEINES‐QoL intrinsic method (VEINES‐QoL int ). At 3 months, signs and symptoms were assessed for the total and separate items of the Villalta score, and healthcare costs were calculated. Results The compression groups had lower overall objective Villalta scores than the no‐compression group (1.47 [standard deviation (SD) 1.570] and 1.59 [SD 1.64] versus 2.21 [SD 2.15]). The differences were mainly attributable to irreversible skin signs (induration, hyperpigmentation, and venectasia) and pain on calf compression. Subjective and total Villalta scores were similar across groups. Differences in HRQOL were only observed at 1 month; HRQOL was better for hosiery (EQ‐5D 0.86 [SD 0.18]; VEINES‐QoL int 0.66 [SD 0.18]) than for multilayer compression bandaging (EQ‐5D 0.81 [SD 0.23; VEINES‐QoL int 0.62 [SD 0.19]). Mean healthcare costs per patient were €417.08 (€354.10 to €489.30) for bandaging, €114.25 (€92.50 to €198.43) for hosiery, and €105.86 (€34.63 to €199.30) for no compression. Conclusions Initial compression reduces irreversible skin signs, edema, and pain on calf compression. Multilayer bandaging is slightly more effective than hosiery, but has substantially higher costs, without a gain in HRQOL. From a patient and economic perspective, compression hosiery would be preferred when initial compression is applied. Trial registration: IDEAL DVT study ClinicalTrials.gov number, NCT01429714.