Related Experiment Video

Updated: Aug 29, 2026

Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
06:45

Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis

Published on: February 10, 2023

The economics of venous thromboembolism prophylaxis: a primer for clinicians

Bruce L Davidson1, Sean D Sullivan, Susan R Kahn

  • 1Pulmonary and Critical Care Medicine Division, Swedish Medical Center and University of Washington School of Medicine, 801 Broadway, Suite 915, Seattle, WA 98122, USA. brucedavidson@pobox.com

Chest
|December 12, 2003
PubMed

Insights

Cost-effectiveness analysis aids decisions on expensive innovations but not on "sufficient" cheaper options. Modeling prophylaxis for venous thromboembolism (VTE) after surgery can compare costs and outcomes to guide preferable choices.

Area of Science:

  • Health Economics
  • Clinical Decision Making
  • Pharmacoeconomics

Background:

  • Health systems face challenges in choosing between costly innovations and less expensive alternatives.
  • Formulary committees often select medications based on cost when deemed "mostly equivalent" in efficacy and safety, potentially conflicting with clinician judgment.
  • Numerous preventive modalities exist for venous thromboembolism (VTE) prophylaxis following orthopedic surgery, each with varying costs, safety, and efficacy profiles.

Purpose of the Study:

  • To explore the limitations of cost-effectiveness analyses in certain healthcare decision-making scenarios.
  • To highlight the need for methods to evaluate the "sufficiency" of less expensive medical interventions.
  • To demonstrate a modeling approach for comparing different VTE prophylaxis strategies after hip and knee replacement and hip fracture surgery.

Main Methods:

  • Reviewing the role of cost-effectiveness information in health system decision-making.
  • Identifying the limitations of current analyses regarding "sufficient" interventions.
  • Developing a framework to model and compare safety, efficacy, and cost outcomes of various VTE prophylaxis modalities.

Main Results:

  • Cost-effectiveness analysis is valuable for incremental innovations but insufficient for determining the "sufficiency" of lower-cost options.
  • A gap exists in decision-making tools when interventions are considered "mostly equivalent" but differ in cost.
  • Modeling allows for the systematic comparison of safety and efficacy outcomes against costs for VTE prophylaxis.

Conclusions:

  • Health system decision-making requires methods beyond traditional cost-effectiveness to evaluate "sufficient" interventions.
  • A structured approach to modeling prophylaxis options can inform preferable choices by integrating safety, efficacy, and cost.
  • Understanding the rationale behind formulary decisions is crucial for clinician buy-in and optimal patient care in VTE prevention.

Related Concept Videos

Venous Thrombosis III: Interprofessional Care01:29

Venous Thrombosis III: Interprofessional Care

Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
Venous Thrombosis IV: Nursing Management01:30

Venous Thrombosis IV: Nursing Management

Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...
Venous Thrombosis I: Introduction01:30

Venous Thrombosis I: Introduction

Venous thrombosis, the most common disorder of the veins, involves the formation of a thrombus or blood clot associated with vein inflammation. It can be classified as either superficial vein thrombosis or deep vein thrombosis.Superficial Vein Thrombosis: This involves the formation of a thrombus in a superficial vein, usually the greater or lesser saphenous vein. Though less severe than deep vein thrombosis (DVT), SVT can lead to complications if untreated.Deep Vein Thrombosis (DVT): This...
Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies01:20

Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies

The key difference between Superficial Vein Thrombosis (SVT) and Deep Vein Thrombosis (DVT) lies in their location and severity.Clinical ManifestationsSVT typically presents with localized pain, tenderness, and redness along the course of a superficial vein, often accompanied by a palpable, cord-like structure under the skin. This condition is usually less dangerous than DVT but can be uncomfortable and may lead to complications such as cellulitis or, rarely, a clot extension into the deep...
Pulmonary Embolism III: Nursing Management01:27

Pulmonary Embolism III: Nursing Management

A pulmonary embolism occurs when a thrombus, amniotic fluid, tumor tissue, fat, or air embolus blocks one or more pulmonary arteries. Effective nursing management and patient education are crucial for improving outcomes and preventing recurrence.Nursing management starts with obtaining a comprehensive patient history, particularly noting any history of deep vein thrombosis (DVT). Assess for clinical manifestations, including dyspnea, chest pain, crackles, heart murmurs, and signs of right-sided...
Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care01:29

Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care

Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...