Document Detail

Cost-effectiveness of additional catheter-directed thrombolysis for deep vein thrombosis.
MedLine Citation:
PMID:  23452204     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Additional treatment with catheter-directed thrombolysis (CDT) has recently been shown to reduce post-thrombotic syndrome (PTS).
OBJECTIVES: To estimate the cost effectiveness of additional CDT compared with standard treatment alone.
METHODS: Using a Markov decision model, we compared the two treatment strategies in patients with a high proximal deep vein thrombosis (DVT) and a low risk of bleeding. The model captured the development of PTS, recurrent venous thromboembolism and treatment-related adverse events within a lifetime horizon and the perspective of a third-party payer. Uncertainty was assessed with one-way and probabilistic sensitivity analyzes. Model inputs from the CaVenT study included PTS development, major bleeding from CDT and utilities for post DVT states including PTS. The remaining clinical inputs were obtained from the literature. Costs obtained from the CaVenT study, hospital accounts and the literature are expressed in US dollars ($); effects in quality adjusted life years (QALY).
RESULTS: In base case analyzes, additional CDT accumulated 32.31 QALYs compared with 31.68 QALYs after standard treatment alone. Direct medical costs were $64,709 for additional CDT and $51,866 for standard treatment. The incremental cost-effectiveness ratio (ICER) was $20,429/QALY gained. One-way sensitivity analysis showed model sensitivity to the clinical efficacy of both strategies, but the ICER remained < $55,000/QALY over the full range of all parameters. The probability that CDT is cost effective was 82% at a willingness to pay threshold of $50,000/QALY gained.
CONCLUSIONS: Additional CDT is likely to be a cost-effective alternative to the standard treatment for patients with a high proximal DVT and a low risk of bleeding.
T Enden; S Resch; C White; H S Wik; N E Kløw; P M Sandset
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of thrombosis and haemostasis : JTH     Volume:  11     ISSN:  1538-7836     ISO Abbreviation:  J. Thromb. Haemost.     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-07-04     Completed Date:  2014-02-07     Revised Date:  2014-05-23    
Medline Journal Info:
Nlm Unique ID:  101170508     Medline TA:  J Thromb Haemost     Country:  England    
Other Details:
Languages:  eng     Pagination:  1032-42     Citation Subset:  IM    
Copyright Information:
© 2013 International Society on Thrombosis and Haemostasis.
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MeSH Terms
Anticoagulants / chemistry
Blood Coagulation Disorders / complications
Catheters / economics*
Cost-Benefit Analysis
Markov Chains
Models, Statistical
Quality of Life
Quality-Adjusted Life Years
Sensitivity and Specificity
Thrombolytic Therapy / economics*,  methods*
Venous Thrombosis / economics*,  therapy*
Grant Support
Reg. No./Substance:
Comment In:
J Thromb Haemost. 2013 Jun;11(6):1029-31   [PMID:  23581286 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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