Individually shortened duration versus standard duration of elastic compression therapy for prevention of post-thrombotic syndrome: a cost-effectiveness analysis

Amin, Elham E.; Cate‐Hoek, Arina J. ten; Bouman, A.C.; Meijer, Karina; Tick, Lidwine W.; Mostard, Guy J M; Wolde, Marije ten; Heiligenberg, Simone van den; Wissen, Sanne van; Poel, Marlène van de; Villalta, Sabina; Serné, Erik H.; Otten, Hans Martin; Klappe, E. H.; Prandoni, Paolo; Prins, Martin H.; Cate, Hugo Ten; Joore, Manuela A.

doi:10.1016/s2352-3026(18)30151-0

Cited by 16 publications

(8 citation statements)

References 27 publications

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“…This strategy proved to be highly efficient as treatment could be stopped at six months in 54.6% of patients and in an additional 10% of patients at 12 months, and this strategy was also demonstrated to be highly cost effective. 210 A practical algorithm to guide contemporary practice regarding use of ECS in DVT is shown in Fig. 3 Recommendation 31…”

Section: Classmentioning

confidence: 99%

Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis

Kakkos

Gohel²,

Bækgaard

et al. 2021

European Journal of Vascular and Endovascular Surgery

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Section: Classmentioning

confidence: 99%

Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis

Kakkos

Gohel²,

Bækgaard

et al. 2021

European Journal of Vascular and Endovascular Surgery

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400

323

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“…17 A recent trial in patients with acute DVT showed that 16.1% of patients received home care, though this included patients who required home care for the initial compression phase. 18 Finally, a decision regarding ECS therapy duration will be made during regular outpatient clinic visits (only in DVT), whereas ECS therapy is permanent for patients with CVI. ECS therapy is a complex process, with various healthcare professionals and patients collaborate and constantly, purposely or not, adjust their performances to each other and the working conditions (for example, restrictions in time, information or resources).…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Using the Functional Resonance Analysis Method to explore how elastic compression therapy is organised and could be improved from a multistakeholder perspective

et al. 2021

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ObjectivesElastic compression stocking (ECS) therapy is an important treatment for patients with deep venous thrombosis (DVT) and chronic venous insufficiency (CVI). This study aimed to provide insight into the structure and variability of the ECS therapy process, its effects on outcomes, and to elicit improvement themes from a multiple stakeholder perspective.DesignThirty semi-structured interviews with professionals and patients were performed. The essential functions for the process of ECS therapy were extracted to create two work-as-done models using the Functional Resonance Analysis Method (FRAM). These findings were used to guide discussion between stakeholders to identify improvement themes.SettingTwo regions in the Netherlands, region Limburg and region North-Holland, including an academic hospital and a general hospital and their catchment region.ParticipantsThe interviewees were purposely recruited and included 25 healthcare professionals (ie, general practitioners, internists, dermatologists, nurses, doctor’s assistants, occupational therapists, home care nurses and medical stocking suppliers) and 5 patients with DVT or CVI.ResultsTwo FRAM models were created (one for each region). The variability of the functions and their effect on outcomes, as well as interdependencies between functions, were identified. These were presented in stakeholder meetings to identify the structure of the process and designated variable and uniform parts of the process and its outcomes. Ultimately, six improvement themes were identified: dissemination of knowledge of the entire process; optimising and standardising initial compression therapy; optimising timing to contact the medical stocking supplier (when oedema has disappeared); improving the implementation of assistive devices; harmonising follow-up duration for patients with CVI; personalising follow-up and treatment duration in patients with DVT.ConclusionsThis study provided a detailed understanding of how ECS therapy is delivered in daily practice by describing major functions and variability in performances and elicited six improvement themes from a multistakeholder perspective.

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“…The IDEAL-DVT trial showed that an individually shortened duration of ECS therapy based on clinical assessments using the Villalta score was non-inferior to standard ECS treatment duration. The subsequent cost-effectiveness analysis of this trial showed that this new approach was cost effective compared to standard ECS treatment duration [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

Budget Impact of Three Improvement Targets for Compression Therapy for Patients with Deep Venous Thrombosis in The Netherlands

Schreurs

Cate‐Hoek

Cate

et al. 2023

PharmacoEconomics Open

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Background and Objective Compression therapy following deep venous thrombosis in the Netherlands is suboptimal. We assessed the budget impact of targeted care improvements. Methods We calculated the per-patient and population healthcare resource use and costs concerning 26,500 new patients each year in the Netherlands for the current pathways in region North Holland (divided into two parts: NH-A and NH-B) and region Limburg. Next, we assessed the impact of three improvement targets: optimizing initial compression therapy, early consultation of an occupational therapist, and tailored duration of elastic compression stocking therapy. Inputs were based on interview ( n = 30) and survey data ( n = 114), literature, and standard prices. The robustness of the results was tested by sensitivity analyses. Results The current per-patient costs for a 2-year episode were €1046 (NH-A), €947 (NH-B), and €1256 (Limburg). The improvements led to direct savings for region Limburg (€4.7 million). Population costs increased in the first year for NH-A (+ €3.5 million) and NH-B (+ €6.4 million), and decreased in the second and third year resulting in a cost reduction for NH-A (− €2.2 million) but not for NH-B (+ €0.6 million). Workload for occupational therapists and internists in North Holland increased, and workload for home care nurses decreased in all regions. Conclusions This study provides a detailed insight into current costs and healthcare resource use associated with compression therapy and the potential impact of implementing three improvement targets. We showed that the improvements resulted in considerable cost savings within 3 years after implementation for region NH-A and Limburg. Supplementary Information The online version contains supplementary material available at 10.1007/s41669-023-00403-4.

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Individually shortened duration versus standard duration of elastic compression therapy for prevention of post-thrombotic syndrome: a cost-effectiveness analysis

Cited by 16 publications

References 27 publications

Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis

Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis

Using the Functional Resonance Analysis Method to explore how elastic compression therapy is organised and could be improved from a multistakeholder perspective

Budget Impact of Three Improvement Targets for Compression Therapy for Patients with Deep Venous Thrombosis in The Netherlands

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