Cost-effectiveness of thromboprophylaxis with intermittent pneumatic compression at cesarean delivery

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.