Key result
IVC filters cut symptomatic PE ~84%, but cost-effectiveness requires prolonged anticoagulation contraindication.
Why the study?
The economic implications of using vena cava filters to prevent symptomatic pulmonary embolism in trauma patients who cannot be anticoagulated remain unclear.
Is early placement of vena cava filters cost-effective for preventing symptomatic pulmonary embolism in trauma patients with contraindications to prophylactic anticoagulation?
RCT (n=240)
Is early placement of vena cava filters cost-effective for preventing symptomatic pulmonary embolism in trauma patients with contraindications to prophylactic anticoagulation?
Absolute Event Rate: 0.9% vs 5.5%
p-value: p=0.048
Vena cava filters are not cost-effective for preventing PE in trauma patients with short-term contraindications to anticoagulation, but are cost-effective if contraindications persist beyond 7 days.
Vena cava filter placement is cost-prohibitive for most trauma patients; leaves open possible value only if anticoagulation contraindications exceed 7 days.
Introduction: Vena cava filters have been used as a primary means to prevent symptomatic pulmonary embolism (PE) in trauma patients who cannot be anticoagulated after severe injury, but the economic implications for this practice remain unclear. Methods: Using a healthcare system perspective to analyze the a priori primary outcome of the da Vinci trial, we report the cost-effectiveness of using vena cava filters as a primary means to prevent PE in patients who have contraindications to prophylactic anticoagulation after major trauma. Results: Of the 240 patients enrolled, complete, prospectively collected, hospital cost data during the entire hospital stay − including costs for the filter, medical/nursing/allied health staff, medical supplies, pathology tests, and radiological imaging − were available in 223 patients (93%). Patients allocated to the filter group ( n = 114) were associated with a reduced risk of PE (0.9%) compared to those in the control group ( n = 109, 5.5%; p = 0.048); and the filter’s benefit was more pronounced among those who could not be anticoagulated within 7 days (filter: 0% vs control: 16%, Bonferroni-corrected p = 0.02). Overall, the cost needed to prevent one PE was high (AUD $379,760), but among those who could not be anticoagulated within 7 days, the costs to prevent one PE (AUD $36,156; ~ USD $26,032) and gain one quality-adjusted life-year (AUD $30,903; ~ USD $22,250) were substantially lower. Conclusion: The cost of using a vena cava filter to prevent PE for those who have contraindications to prophylactic anticoagulation within 3 days of injury is prohibitive, unless such contraindications remain for longer than 7 days. (Australian New Zealand Clinical Trials Registry no.: ACTRN12614000963628)
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A 2021 study conducted an RCT in Major trauma with contraindications to prophylactic anticoagulation (n=240). Vena cava filter vs. Control was evaluated on Symptomatic pulmonary embolism (p=0.048). Vena cava filters reduced symptomatic pulmonary embolism compared to control (0.9% vs 5.5%; p=0.048), but cost-effectiveness was only favorable if anticoagulation was contraindicated for >7 days.
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