THE COST-EFFECTIVENESS OF MECHANICAL FORMS OF DVT PROPHYLAXIS IN GENERAL-SURGERY

Graduated elastic compression (GEC) and intermittent pneumatic compres sion (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 ev ents prevented by current prophylaxis, and the cost associated with th ese events, as well as their avoidance with prophylaxis. In 6 studies, GEC stockings were shown to produce a 64% reduction in DVT in patient s undergoing general surgery. The mean incidence of DVT in 525 unproph ylaxed 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 incide nce of DVT in 665 patients in the control group was 26% and in the tre atment group 6.8% (95% CI 4.8-8.8). Based on the efficacy and risk red uction that DVT prophylaxis provides, the total cost-effectiveness of prophylaxis was calculated per 1000 patients. The cost of no prophylax is in general surgery was pound 23,300. The cost of various methods of prophylaxis, including pharmacological as well as mechanical modaliti es, plus the cost of treating the few DVT that become clinically manif est despite prophylaxis is less expensive than that of using no prophy laxis at all. GEC stockings are cost-effective in low-risk surgical pa tients and can be used in combination with other methods of prevention in moderate and high risk surgical patients. IPC is also a cost-effec tive modality of prophylaxis in general surgery. We conclude that mech anical prophylaxis provides the most cost-effective method for prevent ing DVT in patients undergoing low and moderate risk surgery.