HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Casele, H. Articles by Grobman, W. A. Search for Related Content PubMed PubMed Citation Articles by Casele, H. Articles by Grobman, W. A. Related Collections Cost effective analysis Medical complications of pregnancy

Cost-effectiveness of Thromboprophylaxis With Intermittent Pneumatic Compression at Cesarean Delivery

From the ¹Department of Obstetrics and Gynecology, Section of Maternal–Fetal Medicine, Northwestern University Medical School, Chicago, Illinois.

OBJECTIVE: To evaluate the cost-effectiveness of thromboprophylaxis at cesarean delivery with intermittent pneumatic compression.

METHODS: A decision tree model using Markov analysis was developed to compare two approaches to perioperative care at the time of cesarean delivery: 1) no use of perioperative thromboprophylaxis and 2) the use of intermittent pneumatic compression for thromboprophylaxis at the time of cesarean delivery. Postcesarean deep venous thrombosis was estimated to occur in 0.7% of patients (75% of whom were asymptomatic), and result in a 9% chance of postthrombotic syndrome. Mechanical prophylaxis was assumed to decrease the risk of deep venous thrombosis by 70% and to cost $120. Probability of morbidity and mortality of venous thromboembolism as well as anticoagulation and the costs and utilities for different health state were derived from published studies. Sensitivity analysis was performed over a wide range of variable estimates.

RESULTS: Using the assumptions in our base case, routine thromboprophylaxis for cesarean delivery cost $39,545 per quality-adjusted life year. One-way sensitivity analysis revealed that as long as the incidence of postcesarean deep venous thrombosis was at least 0.68%, intermittent pneumatic compression reduced the incidence of deep venous thrombosis by at least 50%, or the cost of intermittent pneumatic compression was less than $180, the cost-effectiveness of mechanical prophylaxis did not exceed $50,000 per quality-adjusted life year.

CONCLUSION: Mechanical thromboprophylaxis is estimated to be a cost-effective strategy under a wide range of circumstances.

LEVEL OF EVIDENCE: III