Introduction: Studies have evaluated various regimens for prophylaxis against VTE in neurosurgical patients, but optimal choice of VTE prophylaxis in patients with brain tumor remains controversial. Our aim was to perform a cost-effectiveness analysis (CEA) of various prophylactic measures employed to reduce VTE in patients undergoing craniotomy for brain tumor.
Methods: We searched for studies examining VTE prophylaxis in patients undergoing craniotomy for brain tumor between 1973 and 2013. We restricted analysis to studies which examined either mechanical prophylaxis (MP) alone, MP + low-molecular-weight heparin (LMWH) or MP + unfractionated heparin (UFH). Each study had at least 30 days follow-up, and specified whether VTE was symptomatic. Development of symptomatic VTE and/or ICH within 30-days of craniotomy was considered the end-point. Outcome was reported in QALYs. Cost data was collected from Healthcare Cost and Utilization Project (HCUP) database and other published sources (reported in 2013 US$).
Results: We identified 11 studies that satisfied the inclusion criteria for CEA. The probability of VTE was 1.1% in the UFH arm, 2.56% in LMWH arm, and 2.59% in the MP arm. The corresponding probabilities of developing ICH were 0.37%, 2.79%, and 0%, respectively. The average cost/QALY was $299.34 for UFH, $333.20 for MP and $993.92 for LMWH.
Conclusions: Our model suggests that in patients undergoing craniotomy for brain tumor, UFH is the most cost-effective VTE prophylaxis.
Patient Care: This facilitates the most cost effective way of using various prophylaxis measure to prevent VTE in patients undergoing craniotomy for tumor.
Learning Objectives: Learn about the most cost effective measure to prevent VTE in tumor patients undergoing craniotomy.