Cost-Effectiveness of Extended Duration Venous Thromboembolism Prophylaxis in High Risk Urological Oncology Surgical Patients

Major urological oncology surgery carries a significant risk of postoperative venous thromboembolism events, resulting in major morbidity, possible mortality and substantial costs. We determined the incremental cost-effectiveness for in-hospital and low molecular weight heparin extended duration prophylaxis for venous thromboembolism prevention in patients at high risk following major urological oncology surgery.A decision analytical model was developed to compare inpatient hospital costs, venous thromboembolism incidence within 365 days and outcomes associated with extended duration prophylaxis for 4 prophylaxis strategies. The 4 strategies grouped by protocol adherence were 1) per protocol in-hospital prophylaxis with extended duration prophylaxis in 88 cases, 2) per protocol in-hospital prophylaxis without extended duration prophylaxis in 42, 3) not per protocol in-hospital prophylaxis with extended duration prophylaxis in 80 and 4) not per protocol in-hospital prophylaxis without extended duration prophylaxis in 99. Between June 2011 and March 2014, 707 patients underwent major urological oncology surgery. Using the Caprini risk score 309 patients were at high risk.The group 1 strategy was the dominant (most effective) strategy when the probability of preventing venous thromboembolism with extended duration prophylaxis was greater than 80%. Effectiveness for preventing venous thromboembolism was most influenced by the group 2 venous thromboembolism incidence rate. Costs in group 1 vs group 2 were calculated at $1,531 vs $1,563. Using the incremental cost-effectiveness ratio to compare groups 1 and 2, which were the 2 groups with the closest costs and effectiveness, an overall cost savings of $1,390 per patient was seen.Compared with competing strategies in-hospital and extended duration prophylaxis for venous thromboembolism prevention in patients at high risk undergoing major urological oncology surgery is effective to prevent venous thromboembolism and it is cost saving.