Hull RD, Hirsh J, Sackett DL, Stoddart GL.
Cost-effectiveness of primary and secondary prevention of fatal pulmonary
embolism in high-risk surgical patients.
Can Med Assoc J 1982 Nov 15;127(10):990-5

Because death due to pulmonary embolism is relatively rare following general
surgery, many question the need for prophylaxis. In addition, there has been
reluctance to apply new interventions whose cost-effectiveness has not been
adequately evaluated. A cost-effectiveness analysis based on over 1000 high-risk
patients undergoing abdominothoracic surgery, with effectiveness measured in
terms of numbers of deaths from pulmonary embolism averted, has shown
subcutaneous administration of heparin in low doses starting 2 hours before the
operation to be the most cost-effective of several active approaches to
prophylaxis. It averted seven of the eight deaths expected without active
prophylaxis per 1000 such patients and cost half as much as the traditional
approach of intervening only when venous thromboembolism becomes clinically
apparent. Intravenous administration of dextran, although effective, was
expensive, and leg scanning with iodine-125-labelled fibrinogen was extremely
expensive. Intermittent pneumatic compression of the legs was inexpensive, but,
as with leg scanning, its effectiveness has not been determined in randomized
trials.