COST-EFFECTIVENESS OF ADDING INTERMITTENT PNEUMATIC COMPRESSION TO PHARMACOLOGICAL THROMBOPROPHYLAXIS AFTER TOTAL HIP AND KNEE ARTHROPLASTY: A FRENCH HEALTH-SYSTEM ANALYSIS
Author(s)
Kristen La Salle, BSc BAppSci, JD1, Luis Cortez Huerta, MSc2, Beata Dymek, BSc, MSc3, amandine Giraud-Sauveur, MSc4, Ernesto M. Nogueira, MBA5.
1Cardinal Health, Melbourne, Australia, 2Cardinal Health, Santiago, Chile, 3Cardinal Health, Ancaster, ON, Canada, 4Cardinal Health, Paris, France, 5ValueConnected, The Hague, Netherlands.
1Cardinal Health, Melbourne, Australia, 2Cardinal Health, Santiago, Chile, 3Cardinal Health, Ancaster, ON, Canada, 4Cardinal Health, Paris, France, 5ValueConnected, The Hague, Netherlands.
OBJECTIVES: To evaluate, from a French health-system perspective, the lifetime cost-effectiveness of adding intermittent pneumatic compression (IPC) to standard pharmacological venous thromboembolism (VTE) prophylaxis with low-molecular-weight heparin (LMWH) after elective total hip and knee arthroplasty.
METHODS: A decision-analytic model with a 90-day acute phase and a lifetime phase compared LMWH alone with LMWH plus IPC (combined). It captured symptomatic VTE, major bleeding, post-thrombotic syndrome (PTS) after DVT, and fatal pulmonary embolism (PE). The combined VTE rate was anchored to the CRISTAL randomised trial; the incremental effect of IPC was from an orthopaedic total hip arthroplasty study (Daniel 2008); PTS incidence and costs, PE case-fatality (17%), bleeding and utilities were from NICE NG89 (case-fatality within the 2019 ESC range). Costs (2018-2026 EUR) included the IPC device acquisition cost, the French LMWH price, the 2018 PMSI procedure cost, French complication costs, and lifetime PTS costs. Costs and QALYs were discounted at 2.5%. As France applies no fixed willingness-to-pay threshold, incremental cost per QALY is reported, with one-way sensitivity analyses.
RESULTS: Adding IPC reduced symptomatic 90-day VTE from 4.0% to 1.8%; per 1,000 patients this avoided 22 VTE, 3.9 PTS cases, and 1.1 fatal PE. Incremental cost was €19 per patient for 0.013 QALYs — an incremental cost-effectiveness ratio of approximately €1,500 per QALY. In one-way sensitivity analyses it stayed cost-effective; a conservative IPC-effect estimate gave approximately €21,900 per QALY (below €30,000).
CONCLUSIONS: From a French health-system perspective, adding IPC to standard pharmacological prophylaxis after total hip and knee arthroplasty reduced symptomatic VTE and was cost-effective (approximately €1,500 per QALY over a lifetime horizon), driven by avoided post-thrombotic syndrome and fatal PE. As effect estimates reflect a specific IPC device, results may not generalise to other systems or scenarios.
METHODS: A decision-analytic model with a 90-day acute phase and a lifetime phase compared LMWH alone with LMWH plus IPC (combined). It captured symptomatic VTE, major bleeding, post-thrombotic syndrome (PTS) after DVT, and fatal pulmonary embolism (PE). The combined VTE rate was anchored to the CRISTAL randomised trial; the incremental effect of IPC was from an orthopaedic total hip arthroplasty study (Daniel 2008); PTS incidence and costs, PE case-fatality (17%), bleeding and utilities were from NICE NG89 (case-fatality within the 2019 ESC range). Costs (2018-2026 EUR) included the IPC device acquisition cost, the French LMWH price, the 2018 PMSI procedure cost, French complication costs, and lifetime PTS costs. Costs and QALYs were discounted at 2.5%. As France applies no fixed willingness-to-pay threshold, incremental cost per QALY is reported, with one-way sensitivity analyses.
RESULTS: Adding IPC reduced symptomatic 90-day VTE from 4.0% to 1.8%; per 1,000 patients this avoided 22 VTE, 3.9 PTS cases, and 1.1 fatal PE. Incremental cost was €19 per patient for 0.013 QALYs — an incremental cost-effectiveness ratio of approximately €1,500 per QALY. In one-way sensitivity analyses it stayed cost-effective; a conservative IPC-effect estimate gave approximately €21,900 per QALY (below €30,000).
CONCLUSIONS: From a French health-system perspective, adding IPC to standard pharmacological prophylaxis after total hip and knee arthroplasty reduced symptomatic VTE and was cost-effective (approximately €1,500 per QALY over a lifetime horizon), driven by avoided post-thrombotic syndrome and fatal PE. As effect estimates reflect a specific IPC device, results may not generalise to other systems or scenarios.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE267
Topic
Economic Evaluation, Medical Technologies, Study Approaches
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), Surgery