Cost Effectiveness of Mechanical Thrombectomy Versus Anticoagulation for Treating Iliofemoral Deep Vein Thrombosis in the UK.

Abstract

Interventional methods, such as mechanical thrombectomy (MT) and catheter directed thrombolysis, offer an alternative strategy for managing deep vein thrombosis (DVT) that may reduce the incidence of subsequent complications, such as post-thrombotic syndrome (PTS). However, such methods incur higher initial treatment costs compared with the standard of care (i.e., anticoagulation [AC]), and it is unclear whether those higher costs are mitigated by the reduction in PTS. This study aimed to evaluate the lifetime health utility of MT plus AC compared with AC alone in the UK. A combined decision tree and Markov model was implemented to evaluate complications from a healthcare payer's perspective over a lifetime horizon in patients with acute and subacute (i.e., symptom duration four or fewer weeks) iliofemoral DVT treated with either MT or AC. Resource use and cost estimates were sourced from published literature and were evaluated in terms of inflation adjusted 2021 British pounds sterling (£). Complication rates, PTS health state transition probabilities, and health utilities were established from a published cohort of 164 pairs of propensity score matched patients treated with MT or AC from the CLOUT registry and ATTRACT trial, respectively. Study outcomes included lifetime cost per patient, quality adjusted life years (QALYs), and cost effectiveness. MT resulted in lower lifetime costs (£20 889 vs. £26 193) and greater mean lifetime QALYs (15.4 vs. 14.3) compared with AC. Thus, MT was dominant compared with the standard of care, with a net monetary benefit of £27 904 at a willingness to pay threshold of £20 000. Results of the univariable and probabilistic sensitivity analyses were consistent with the deterministic result, suggesting robustness of the model results. Despite greater initial treatment costs, intervention in acute and subacute lower extremity DVT with MT is cost effective in the UK. Results suggest that patient benefit is realised over a lifetime horizon by reducing PTS incidence and associated costs. Randomised controlled trials will validate these potential clinical and economic benefits.