Cost-effectiveness of deep venous thrombosis prophylaxis in gynecologic oncology surgery

Objective: To estimate the cost-effectiveness of preventive strategies for deep Vein thrombosis (DVT) in patients undergoing surgery for gynecologic c ancer. Methods: A model was constructed to estimate the costs and outcomes associa ted 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 em bolus (PE) prevented, and per life-year saved. Probability estimates for va rious 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 fo r 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 a nd unfractionated heparin were cost-effective compared with no prophylaxis, each was less effective than external pneumatic compression in the base cas e. The results of the analysis were sensitive to assumptions about the rela tive risk of DVT, the life expectancy of the patient, the costs of future t reatment, and the relative effectiveness of the different strategies: if un fractionated heparin or low molecular weight heparin is at least 2-3% more effective than external pneumatic compression, then the incremental cost pe r life-year of either would be less than $50,000 compared with external pne umatic compression. Conclusion: Prophylaxis of DVT is cost-effective in terms of life-years gai ned even for patients with. relatively short life expectancies, such as ova rian cancer patients. External pneumatic compression appears to be the most cost-effective strategy under our baseline assumptions, but further studie s in gynecologic cancer are needed to validate our conclusions. (C) 2000 by The American College of Obstetricians and Gynecologists.