Cost-effective prevention of pulmonary embolus in high-risk trauma patients

Objective: To define the cost-effectiveness of screening ultrasound (US) and prophylactic inferior vena cava filters (VCF), approaches aimed at reducing the incidence of pulmonary embolus (PE) in high-risk trauma patients. Design: Cost-effective analysis. Materials and Methods: We constructed a decision tree with three approaches for PE prevention: no intervention, US, and VCF. Probabilities in each subtree were taken from published data. Sensitivity analyses evaluated all assumptions, probabilities, and outcomes for effects on baseline conclusions. Results: US is more cost-effective than VCF, with a cost/PE prevented of $46,300 compared with $93,700. The strategies become equally cost-effective only when VCF are placed in the radiology suite and length of stay is ≤ 2 weeks. Conclusions: US is the most cost-effective approach for PE prevention in high-risk trauma patients. VCF should be reserved for patients with an anticipated length of stay ≤ 2 weeks who can safely have a filter placed in the radiology suite.