OBJECTIVES: Total hip and knee arthroplasty(THKA) patients are at risk of venous thromboembolism(VTE).Guidelines recommend 10‑35 days of pharmacoprophylaxis which may induce bleeding, resulting in increased healthcare costs. This study assessed whether using intermittent pneumatic compression (IPC) for VTE prophylaxis is associated with reduced healthcare costs compared to anticoagulants.

METHODS: Studies related to VTE and prophylaxis in THKA were identified by a structured PubMed database search.VTE incidence and cost data were Australia specific or, if not available, were taken from other developed healthcare systems.A Markov model was used to estimate the incidence of deep vein thrombosis(DVT), pulmonary embolism(PE), death, post-thrombotic syndrome(PTS), as well as minor and major bleeding and heparin-induced-thrombocytopenia, to assess the budget impact of different VTE prophylaxis strategies. Low-molecular-weight-heparin(LMWH) was used as reference intervention, effectiveness data were obtained from meta-analyses.

RESULTS: A total of 102,459 THKA were performed in Australia in 2015.The 12-day incidence of DVT and PE using LMWH prophylaxis were 4.48% and 0.25% respectively.Minor and major bleeding occurred in 9.9%(within 12 days) and 1.9%(within 10 days) of the patients respectively.The incidence of VTE was not different between LMWH and IPC after THKA. The model estimated that the total cost of post-operative care for THKA was AUD101.7 million in 2015. A 1%-point change from LMWH to IPC prophylaxis (n=1025 patients) would reduce the total healthcare costs by $317,361 per year(or $310 per patient).Sensitivity analysis including 500 simulations demonstrated a likelihood of 100% for IPC to reduce both costs and bleeding events compared to LMWH.A 1%-point change from dabigatran and rivaroxaban to IPC resulted in total healthcare savings of $320,580 and $702,584 per year respectively.Two-thirds and 99% of the simulations favoured IPC over dabigatran for bleeding and cost savings respectively.

CONCLUSIONS: Using IPC for VTE prophylaxis after THKA has potential to reduce total healthcare costs compared to anticoagulants, primarily through reduced bleeding events.