Maxwell GL, Myers ER, Clarke-Pearson DL.
Cost-effectiveness of deep venous thrombosis prophylaxis in gynecologic oncology
surgery.
Obstet Gynecol 2000 Feb;95(2):206-14

Department of Obstetrics and Gynecology, Duke University Medical Center, Durham,
North Carolina 27710, USA.

OBJECTIVE: To estimate the cost-effectiveness of preventive strategies for deep
vein thrombosis (DVT) in patients undergoing surgery for gynecologic cancer.
METHODS: A model was constructed to estimate the costs and outcomes associated
with the use of external pneumatic compression, unfractionated heparin, and low
molecular weight heparin in women with cervical, endometrial, and ovarian cancer.
We estimated cost per DVT prevented, per fatal pulmonary embolus (PE) prevented,
and per life-year saved. Probability estimates for various outcomes and
efficacies were obtained from the literature, using data specific for gynecologic
patients when available. RESULTS: Cost-effectiveness estimates ranged from $27
per life-year saved for a 55-year-old endometrial cancer patient to $5132 per
life-year saved for a 65-year-old with ovarian cancer. Although low molecular
weight heparin and unfractionated heparin were cost-effective compared with no
prophylaxis, each was less effective than external pneumatic compression in the
base case. The results of the analysis were sensitive to assumptions about the
relative risk of DVT, the life expectancy of the patient, the costs of future
treatment, and the relative effectiveness of the different strategies: If
unfractionated heparin or low molecular weight heparin is at least 2-3% more
effective than external pneumatic compression, then the incremental cost per
life-year of either would be less than $50,000 compared with external pneumatic
compression. CONCLUSION: Prophylaxis of DVT is cost-effective in terms of
life-years gained even for patients with relatively short life expectancies, such
as ovarian cancer patients. External pneumatic compression appears to be the most
cost-effective strategy under our baseline assumptions, but further studies in
gynecologic cancer are needed to validate our conclusions.