Individually shortened duration versus standard duration of elastic compression therapy for prevention of post-thrombotic syndrome: a cost-effectiveness analysis

Elham E. Amin, Arina J. ten Cate-Hoek, Annemieke C. Bouman, Karina Meijer, Lidwine Tick, Saskia Middeldorp, Guy Mostard, Marije ten Wolde, Simone van den Heiligenberg, Sanne van Wissen, Marlene van de Poel, Sabina Villalta, Erik Serné, Hans Martin Otten, Edith Klappe, Paolo Prandoni, Martin H. Prins, Hugo ten Cate, Manuela A. Joore

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: The IDEAL DVT study showed that it was safe to shorten the duration of elastic compression therapy on an individualised basis after deep vein thrombosis for prevention of post-thrombotic syndrome. In this study, we assessed the cost-effectiveness of this strategy. Methods: IDEAL DVT was a multicentre, randomised, non-inferiority trial that included patients with acute proximal deep vein thrombosis of the leg. After 6 months of elastic compression therapy, patients were randomly assigned (1:1) to the standard 2 years of elastic stocking compression therapy or shortened duration of compression therapy based on the patient's Villalta score. For our cost-effectiveness analysis, we assessed quality-adjusted life-years (QALYs), measured with the three-level version of EQ-5D (EQ-5D-3L; Dutch and UK tariff) and the 36-item Short Form Health Survey (SF-36), and costs in € (health-care and societal perspective) according to the intention-to-treat approach. Data were collected at 3, 6, 12, and 24 months after diagnosis of thrombosis. We calculated incremental net monetary benefit using a QALY threshold of €30 000, and obtained bootstrapped means and 95% CIs. IDEAL DVT is registered with ClinicalTrials.gov, number NCT01429714. Findings: Between March 22, 2011, and July 1, 2015, 865 patients were enrolled in IDEAL DVT. 437 were assigned to individualised duration of elastic compression therapy and 428 to standard duration of elastic compression therapy. Nine patients were eventually excluded because of recurrent venous thromboembolism within 6 months after the first event. From a societal perspective, for every QALY lost measured with the EQ-5D Dutch tariff, cost savings were €305·992 (incremental net monetary benefit €3205, 95% CI 502–5741), and for every QALY lost based on the Short-Form Six-Dimension (SF-6D) utility score (derived from SF-36), cost savings were €6030·941 (€3540, 95% CI 1174–5953). Using the UK tariff for EQ-5D, the individualised strategy was more effective and less costly (€4071, 1452–6647). The probability that the individualised strategy was cost-effective was 99% at a threshold of €30 000 per QALY (EQ-5D Dutch tariff). Interpretation: Individually shortened duration of elastic compression therapy was cost-effective compared with standard duration elastic compression therapy. Use of an individualised approach to elastic stocking compression therapy for the prevention of post-thrombotic syndrome after deep vein thrombosis could lead to substantial costs savings without loss in health-related quality of life. Funding: Netherlands Organisation for Health Research and Development.
Original languageEnglish
Pages (from-to)e512-e519
JournalLancet haematology
Volume5
Issue number11
Early online date9 Oct 2018
DOIs
Publication statusPublished - 2018

Cite this

Amin, Elham E. ; ten Cate-Hoek, Arina J. ; Bouman, Annemieke C. ; Meijer, Karina ; Tick, Lidwine ; Middeldorp, Saskia ; Mostard, Guy ; ten Wolde, Marije ; van den Heiligenberg, Simone ; van Wissen, Sanne ; van de Poel, Marlene ; Villalta, Sabina ; Serné, Erik ; Otten, Hans Martin ; Klappe, Edith ; Prandoni, Paolo ; Prins, Martin H. ; ten Cate, Hugo ; Joore, Manuela A. / Individually shortened duration versus standard duration of elastic compression therapy for prevention of post-thrombotic syndrome : a cost-effectiveness analysis. In: Lancet haematology. 2018 ; Vol. 5, No. 11. pp. e512-e519.
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title = "Individually shortened duration versus standard duration of elastic compression therapy for prevention of post-thrombotic syndrome: a cost-effectiveness analysis",
abstract = "Background: The IDEAL DVT study showed that it was safe to shorten the duration of elastic compression therapy on an individualised basis after deep vein thrombosis for prevention of post-thrombotic syndrome. In this study, we assessed the cost-effectiveness of this strategy. Methods: IDEAL DVT was a multicentre, randomised, non-inferiority trial that included patients with acute proximal deep vein thrombosis of the leg. After 6 months of elastic compression therapy, patients were randomly assigned (1:1) to the standard 2 years of elastic stocking compression therapy or shortened duration of compression therapy based on the patient's Villalta score. For our cost-effectiveness analysis, we assessed quality-adjusted life-years (QALYs), measured with the three-level version of EQ-5D (EQ-5D-3L; Dutch and UK tariff) and the 36-item Short Form Health Survey (SF-36), and costs in € (health-care and societal perspective) according to the intention-to-treat approach. Data were collected at 3, 6, 12, and 24 months after diagnosis of thrombosis. We calculated incremental net monetary benefit using a QALY threshold of €30 000, and obtained bootstrapped means and 95{\%} CIs. IDEAL DVT is registered with ClinicalTrials.gov, number NCT01429714. Findings: Between March 22, 2011, and July 1, 2015, 865 patients were enrolled in IDEAL DVT. 437 were assigned to individualised duration of elastic compression therapy and 428 to standard duration of elastic compression therapy. Nine patients were eventually excluded because of recurrent venous thromboembolism within 6 months after the first event. From a societal perspective, for every QALY lost measured with the EQ-5D Dutch tariff, cost savings were €305·992 (incremental net monetary benefit €3205, 95{\%} CI 502–5741), and for every QALY lost based on the Short-Form Six-Dimension (SF-6D) utility score (derived from SF-36), cost savings were €6030·941 (€3540, 95{\%} CI 1174–5953). Using the UK tariff for EQ-5D, the individualised strategy was more effective and less costly (€4071, 1452–6647). The probability that the individualised strategy was cost-effective was 99{\%} at a threshold of €30 000 per QALY (EQ-5D Dutch tariff). Interpretation: Individually shortened duration of elastic compression therapy was cost-effective compared with standard duration elastic compression therapy. Use of an individualised approach to elastic stocking compression therapy for the prevention of post-thrombotic syndrome after deep vein thrombosis could lead to substantial costs savings without loss in health-related quality of life. Funding: Netherlands Organisation for Health Research and Development.",
author = "Amin, {Elham E.} and {ten Cate-Hoek}, {Arina J.} and Bouman, {Annemieke C.} and Karina Meijer and Lidwine Tick and Saskia Middeldorp and Guy Mostard and {ten Wolde}, Marije and {van den Heiligenberg}, Simone and {van Wissen}, Sanne and {van de Poel}, Marlene and Sabina Villalta and Erik Sern{\'e} and Otten, {Hans Martin} and Edith Klappe and Paolo Prandoni and Prins, {Martin H.} and {ten Cate}, Hugo and Joore, {Manuela A.}",
note = "Copyright {\circledC} 2018 Elsevier Ltd. All rights reserved.",
year = "2018",
doi = "10.1016/S2352-3026(18)30151-0",
language = "English",
volume = "5",
pages = "e512--e519",
journal = "Lancet haematology",
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Amin, EE, ten Cate-Hoek, AJ, Bouman, AC, Meijer, K, Tick, L, Middeldorp, S, Mostard, G, ten Wolde, M, van den Heiligenberg, S, van Wissen, S, van de Poel, M, Villalta, S, Serné, E, Otten, HM, Klappe, E, Prandoni, P, Prins, MH, ten Cate, H & Joore, MA 2018, 'Individually shortened duration versus standard duration of elastic compression therapy for prevention of post-thrombotic syndrome: a cost-effectiveness analysis' Lancet haematology, vol. 5, no. 11, pp. e512-e519. https://doi.org/10.1016/S2352-3026(18)30151-0

Individually shortened duration versus standard duration of elastic compression therapy for prevention of post-thrombotic syndrome : a cost-effectiveness analysis. / Amin, Elham E.; ten Cate-Hoek, Arina J.; Bouman, Annemieke C.; Meijer, Karina; Tick, Lidwine; Middeldorp, Saskia; Mostard, Guy; ten Wolde, Marije; van den Heiligenberg, Simone; van Wissen, Sanne; van de Poel, Marlene; Villalta, Sabina; Serné, Erik; Otten, Hans Martin; Klappe, Edith; Prandoni, Paolo; Prins, Martin H.; ten Cate, Hugo; Joore, Manuela A.

In: Lancet haematology, Vol. 5, No. 11, 2018, p. e512-e519.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Individually shortened duration versus standard duration of elastic compression therapy for prevention of post-thrombotic syndrome

T2 - a cost-effectiveness analysis

AU - Amin, Elham E.

AU - ten Cate-Hoek, Arina J.

AU - Bouman, Annemieke C.

AU - Meijer, Karina

AU - Tick, Lidwine

AU - Middeldorp, Saskia

AU - Mostard, Guy

AU - ten Wolde, Marije

AU - van den Heiligenberg, Simone

AU - van Wissen, Sanne

AU - van de Poel, Marlene

AU - Villalta, Sabina

AU - Serné, Erik

AU - Otten, Hans Martin

AU - Klappe, Edith

AU - Prandoni, Paolo

AU - Prins, Martin H.

AU - ten Cate, Hugo

AU - Joore, Manuela A.

N1 - Copyright © 2018 Elsevier Ltd. All rights reserved.

PY - 2018

Y1 - 2018

N2 - Background: The IDEAL DVT study showed that it was safe to shorten the duration of elastic compression therapy on an individualised basis after deep vein thrombosis for prevention of post-thrombotic syndrome. In this study, we assessed the cost-effectiveness of this strategy. Methods: IDEAL DVT was a multicentre, randomised, non-inferiority trial that included patients with acute proximal deep vein thrombosis of the leg. After 6 months of elastic compression therapy, patients were randomly assigned (1:1) to the standard 2 years of elastic stocking compression therapy or shortened duration of compression therapy based on the patient's Villalta score. For our cost-effectiveness analysis, we assessed quality-adjusted life-years (QALYs), measured with the three-level version of EQ-5D (EQ-5D-3L; Dutch and UK tariff) and the 36-item Short Form Health Survey (SF-36), and costs in € (health-care and societal perspective) according to the intention-to-treat approach. Data were collected at 3, 6, 12, and 24 months after diagnosis of thrombosis. We calculated incremental net monetary benefit using a QALY threshold of €30 000, and obtained bootstrapped means and 95% CIs. IDEAL DVT is registered with ClinicalTrials.gov, number NCT01429714. Findings: Between March 22, 2011, and July 1, 2015, 865 patients were enrolled in IDEAL DVT. 437 were assigned to individualised duration of elastic compression therapy and 428 to standard duration of elastic compression therapy. Nine patients were eventually excluded because of recurrent venous thromboembolism within 6 months after the first event. From a societal perspective, for every QALY lost measured with the EQ-5D Dutch tariff, cost savings were €305·992 (incremental net monetary benefit €3205, 95% CI 502–5741), and for every QALY lost based on the Short-Form Six-Dimension (SF-6D) utility score (derived from SF-36), cost savings were €6030·941 (€3540, 95% CI 1174–5953). Using the UK tariff for EQ-5D, the individualised strategy was more effective and less costly (€4071, 1452–6647). The probability that the individualised strategy was cost-effective was 99% at a threshold of €30 000 per QALY (EQ-5D Dutch tariff). Interpretation: Individually shortened duration of elastic compression therapy was cost-effective compared with standard duration elastic compression therapy. Use of an individualised approach to elastic stocking compression therapy for the prevention of post-thrombotic syndrome after deep vein thrombosis could lead to substantial costs savings without loss in health-related quality of life. Funding: Netherlands Organisation for Health Research and Development.

AB - Background: The IDEAL DVT study showed that it was safe to shorten the duration of elastic compression therapy on an individualised basis after deep vein thrombosis for prevention of post-thrombotic syndrome. In this study, we assessed the cost-effectiveness of this strategy. Methods: IDEAL DVT was a multicentre, randomised, non-inferiority trial that included patients with acute proximal deep vein thrombosis of the leg. After 6 months of elastic compression therapy, patients were randomly assigned (1:1) to the standard 2 years of elastic stocking compression therapy or shortened duration of compression therapy based on the patient's Villalta score. For our cost-effectiveness analysis, we assessed quality-adjusted life-years (QALYs), measured with the three-level version of EQ-5D (EQ-5D-3L; Dutch and UK tariff) and the 36-item Short Form Health Survey (SF-36), and costs in € (health-care and societal perspective) according to the intention-to-treat approach. Data were collected at 3, 6, 12, and 24 months after diagnosis of thrombosis. We calculated incremental net monetary benefit using a QALY threshold of €30 000, and obtained bootstrapped means and 95% CIs. IDEAL DVT is registered with ClinicalTrials.gov, number NCT01429714. Findings: Between March 22, 2011, and July 1, 2015, 865 patients were enrolled in IDEAL DVT. 437 were assigned to individualised duration of elastic compression therapy and 428 to standard duration of elastic compression therapy. Nine patients were eventually excluded because of recurrent venous thromboembolism within 6 months after the first event. From a societal perspective, for every QALY lost measured with the EQ-5D Dutch tariff, cost savings were €305·992 (incremental net monetary benefit €3205, 95% CI 502–5741), and for every QALY lost based on the Short-Form Six-Dimension (SF-6D) utility score (derived from SF-36), cost savings were €6030·941 (€3540, 95% CI 1174–5953). Using the UK tariff for EQ-5D, the individualised strategy was more effective and less costly (€4071, 1452–6647). The probability that the individualised strategy was cost-effective was 99% at a threshold of €30 000 per QALY (EQ-5D Dutch tariff). Interpretation: Individually shortened duration of elastic compression therapy was cost-effective compared with standard duration elastic compression therapy. Use of an individualised approach to elastic stocking compression therapy for the prevention of post-thrombotic syndrome after deep vein thrombosis could lead to substantial costs savings without loss in health-related quality of life. Funding: Netherlands Organisation for Health Research and Development.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/30314712

U2 - 10.1016/S2352-3026(18)30151-0

DO - 10.1016/S2352-3026(18)30151-0

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SP - e512-e519

JO - Lancet haematology

JF - Lancet haematology

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