Do Cost Limitations of Extended Prophylaxis After Surgery Apply to Ulcerative Colitis Patients?

This article was originally published here

Dis Colon Rectum. 2021 Nov 22. doi: 10.1097/DCR.0000000000002056. Online ahead of print.

ABSTRACT

BACKGROUND: Colorectal surgery patients with ulcerative colitis are at increased risk of postoperative venous thromboembolism. Extended prophylaxis for thromboembolism prevention has been used in colorectal surgery patients although criticized for its lack of cost-effectiveness. However, the cost-effectiveness of extended prophylaxis for postoperative ulcerative colitis patients may be unique.

OBJECTIVE: To assess the cost-effectiveness of extended prophylaxis in postoperative ulcerative colitis patients.

DESIGN: A decision analysis compared costs and benefits in postoperative ulcerative colitis patients with and without extended prophylaxis over a lifetime horizon.

SETTING: Assumptions for decision analysis were identified from available literature for a typical ulcerative colitis patient’s risk of thrombosis, age at surgery, type of thrombosis, prophylaxis risk reduction, bleeding complications, and mortality.

MAIN OUTCOME MEASURES: Costs ($) and benefits (quality-adjusted life year) reflected a societal perspective and were time-discounted at 3%. Costs and benefits were combined to produce the main outcome measure, the incremental cost-effectiveness ratio ($ per quality-adjusted life year). Multivariable probabilistic sensitivity analysis modeled uncertainty in probabilities, costs, and disutilities.

RESULTS: Using reference parameters, the individual expected societal total cost of care was $957 without and $1,775 with prophylaxis (not cost-effective; $257,280 per quality-adjusted life year). Preventing a single mortality with prophylaxis would cost $5.0 million (number needed to treat: 6,134 individuals). Adjusting across a range of scenarios upheld these conclusions 77% of the time. With further sensitivity testing, VTE cumulative risk (> 1.5%) and ePpx regimen pricing (< $299) were the two parameters most sensitive to uncertainty.

LIMITATIONS: Recommendations of decision analysis methodology are limited to group decision-making, not an individual risk profile.

CONCLUSION: Routine ePpx in postoperative ulcerative colitis patients is not cost-effective. This finding is sensitive to higher than average rates of VTE and low-cost prophylaxis opportunities.

PMID:34840290 | DOI:10.1097/DCR.0000000000002056