The cost-effectiveness of mechanical forms of DVT prophylaxis in general surgery

Graduated elastic compression (GEC) and intermittent pneumatic compression (IPC) are physical methods used for the prevention of deep venous thrombosis (DVT). To determine if this prevention is cost-effective, we reviewed the literature to identify the number of thromboembolic events prevented by current prophylaxis, and the cost associated with these events, as well as their avoidance with prophylaxis. In 6 studies, GEC stockings were shown to produce a 64% reduction in DVT in patients undergoing general surgery. The mean incidence of DVT in 525 unprophylaxed patients was 22.5% and in the treatment group 8.2% (95% CI 2.7-13.7). IPC has been shown to produce a 74% reduction in the incidence of post-operative DVT in 11 studies (general surgery). The mean incidence of DVT in 665 patients in the control group was 26% and in the treatment group 6.8% (95% CI 4.8-8.8). Based on the efficacy and risk reduction that DVT prophylaxis provides, the total cost-effectiveness of prophylaxis was calculated per 1000 patients. The cost of no prophylaxis in general surgery was pound 23,300. The cost of various methods of prophylaxis, including pharmacological as well as mechanical modalities, plus the cost of treating the few DVT that become clinically manifest despite prophylaxis is less expensive than that of using no prophylaxis at all. GEC stockings are cost-effective in low-risk surgical patients and can be used in combination with other methods of prevention in moderate and high risk surgical patients. IPC is also a cost-effective modality of prophylaxis in general surgery. We conclude that mechanical prophylaxis provides the most cost-effective method for preventing DVT in patients undergoing low and moderate risk surgery.