OBJECTIVES

Post-thrombotic syndrome (PTS) is a common sequel to deep vein thrombosis (DVT) that causes a significant reduction in the patient's quality of life. There may be clinical benefit from recanalisation of the iliac vein. This research aims to compare the cost-effectiveness of iliac vein stenting (+ best medical treatment) versus best medical treatment alone from the perspective of the NHS.

METHODS

A probabilistic Markov decision model with a five-year time horizon was used to compare both treatments. The model was set up under four PTS severity states according to the Villalta score reported by the patient (<5: no PTS, 5-9: mild PTS, 10-14: moderate PTS, >14: severe PTS). Transition rates were derived from partially observed data in the literature using Markov Chain Monte Carlo (MCMC) methods. The resource use and costs of the stenting procedure were collected from individual patient hospital data obtained retrospectively from 92 interventions. The costs associated with the severity of PTS were gathered from the literature and national health resources databases. The utility function associated with PTS states of each severity was derived from a meta-regression based on three different sources. Univariate sensitivity analyses and probabilistic sensitivity analysis (Monte Carlo simulation) were conducted.

RESULTS

With 50% of patients starting with severe PTS and 50% moderate, the mean five year ICER was £17,383. The probability of stenting having greatest net benefit was 60% at a threshold of £20,000.

CONCLUSIONS

Univariate sensitivity analysis reveals that stenting is more cost-effective when a higher proportion of patients are treated with a severe condition, when the cost of the procedure is lower, and the dis-utility associated with PTS is lower.