Abstract
Patients with malignant brain tumors and deep venous thrombosis (DVT) of the lower extremities are at high risk of developing pulmonary embolism (PE). We developed a Markov model to compare the cost-effectiveness of two strategies to prevent PE in such patients: intra-vena-caval bird's nest filter (BNF) with anticoagulation versus anticoagulation alone. Using the benchmark of US $50,000 per quality-adjusted life year (QALY), BNF was not cost-effective in this population as it reduced the rate of PE at an incremental cost-effectiveness ratio of $198,852 per QALY gained. However, after adjusting the model to reflect the 5-year mortality rate of hypothetical breast cancer patients, BNF was more effective and less expensive than anticoagulation alone. BNF was effective in reducing the rate of PE but was not cost-effective for patients with brain tumors. BNF could be cost-effective for patients with longer life expectancies.
Similar content being viewed by others
References
Agency for Healthcare Research and Quality (1999) Healthcare cost and utilization project. www.ahrq.gov. Cited 1 Sept 2001
Calligaro KD, Bergen WS, Haut MJ, et al (1991) Thromboembolic complications in patients with advanced cancer: Anticoagulation versus Greenfield filter placement. Ann Vasc Surg 5:186–189
Cantelmo NL, Menzoian JO, Logerfo FW et al (1982) Clinical experience with vena caval filters in high-risk cancer patients. Cancer 50:341–344
Coon W (1984) Venous thromboembolism. Prevalence, risk factors and prevention. Clin Chest Med 5:391–401
Decousus H, Leizorovicz A, Parent F et al (1998) A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. New Engl J Med 338:409–415
Hicks ME, Middleton WD, Picus D et al (1990) Prevalence of local venous thrombosis after transfemoral placement of a bird's nest vena caval filter. J Vasc Interv Radiol 1:63–68
Hubbard K, Roehm Jr JO, Abbruzzese JL (1994) The bird's nest filter. An alternative to long-term oral anticoagulation in patients with advanced malignancies. Am J Clin Oncol 17:115–117
Ihnat DM, Mills JL, Hughes JD et al (1998) Treatment of patients with venous thromboembolism and malignant disease: Should vena cava filter placement be routine? J Vasc Surg 28:800–807
Kobelt G, Jonsson L, Henricksson F et al (2000) Cost-utility analysis of interferon beta-1b in secondary progressive multiple sclerosis. Intl J Tech Assess Health Care 16:768–780
Lea N, Grossman S (1994) Treatment of thromboembolic complications in patients with brain tumors. J Neuro Oncol 22:127–137
Levine M, Lee A (2001) Treatment of venous thrombosis in the cancer patient. Acta Haematol 106:81–87
Marcy P-Y, Magne N, Gallard J-C et al (2002) Cost-benefit assessment of inferior vena cava filter placement in advanced cancer patients. Support Care Cancer 10:76–80
Marras LC, Geerts WH, Perry JR (2000) The risk of venous thromboembolism is increased throughout the course of malignant glioma. Cancer 89:640–6
Nicholson AA, Ettles DF, Paddon AJ et al (1999) Long-term follow-up of the bird's nest IVC filter. Clin Radiol 54:759–764
Partsch H, Kechavarz B, Mostbeck A et al (1996) Frequency of pulmonary embolism in patients who have iliofemoral deep vein thrombosis and are treated with once- or twice-daily low-molecular-weight heparin. J Vasc Surg 24(5): 774–782
Roehm JO, Johnsrude IS, Barth MH et al (1988) The bird's nest inferior vena cava filter: Progress report. Radiology 168:745–749
Ruff R, Posner J (1983) Incidence and treatment of peripheral venous thrombosis in patients with glioma. Ann Neurol 13:334–336
Sawaya R, Zuccarello M, Elkalliny M et al (1992) Postoperative venous thromboembolism and brain tumors: Part i. Clinical profile. J Neuro-Oncol 14:119–125
Schwarz RE, Marrero AM, Caonlon KC et al (1996) Inferior vena cava filters in cancer patients: Indications and outcome. J Clin Oncol 14:652–657
Sonnenberg F, Beck J (1993) Markov models in medical decision making: A practical guide. Med Decis Making 13:322–338
Tengs T, Wallace A (2000) One thousand health-related quality-of-life estimates. Med Care 38:583–637
Walsh DB, Downing S, Nauta R et al (1987) Metastatic cancer: A relative contraindication to vena cava filter placement. Cancer 59:161–163
Winchell R, Hoyt D, Walsh J et al (1994) Risk factors associated with pulmonary embolus despite routine prophylaxis: Implications for improved protection. J Trauma 37:600–606
Wojtowycz M, Stoehr T, Crummy A et al (1997) The bird's nest inferior vena caval filter: Review of a single-center experience. J Vasc Interv Radiol 8:171–179
Author information
Authors and Affiliations
Corresponding author
Additional information
Presented in part at the 36th American Society of Clinical Oncology Meeting, May 2000.
Rights and permissions
About this article
Cite this article
Chau, Q., Cantor, S.B., Caramel, E. et al. Cost-effectiveness of the bird's nest filter for preventing pulmonary embolism among patients with malignant brain tumors and deep venous thrombosis of the lower extremities. Support Care Cancer 11, 795–799 (2003). https://doi.org/10.1007/s00520-003-0520-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-003-0520-2