Inferior vena cava filter retrieval provides no advantage in the average patient

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Health Economics

Background:

• Inferior vena cava (IVC) filters prevent pulmonary embolism (PE) when anticoagulation is not feasible.
• Catheter-based retrieval of IVC filters is technically possible.
• Filter retrieval has associated risks and costs, necessitating a risk-benefit analysis.

Purpose of the Study:

• To quantitatively assess the risks and benefits of IVC filter retrieval versus retention.
• To utilize formal decision analysis for comparing IVC filter management strategies.

Main Methods:

• A Markov state-transition model simulated lifetime outcomes for filter retention vs. retrieval.
• Quality-adjusted life-years (QALYs) were used to express outcomes.
• Analysis incorporated probabilities of PE, filter complications, and mortality, with disutility of treatments.

Main Results:

• In the base case, retaining the IVC filter yielded a higher QALY outcome (22.3 QALYs) compared to retrieval (21.9 QALYs).
• Sensitivity analysis indicated retrieval might be favored if the utility of living with a filter is below 0.98.
• Retaining the filter remained the preferred strategy across various probabilities of retrieval and PE mortality.

Conclusions:

• Retaining a previously placed IVC filter offers an average benefit of 0.4 QALYs over retrieval.
• The decision to retrieve an IVC filter is significantly influenced by the patient's perceived utility of living with the filter.