Value Analysis Regarding DVT Prophylaxis

DimensionCare Option ACare Option BPreferred Option
Population: hospitalized patients with IBD with central line (n = 100/y)No prophylaxisProvide enoxaparin prophylaxis for VTE
Operational factors
 Percent adherence to care (goal 80%)0%–no prophylaxisAnticipate 80%+ if in electronic medical record
 Care delivery team effectsNoneRequires subcutaneous injections and monitoringOption A
 Palatability to patient/familyPreferredLess palatable if all things equal: subcutaneous injections not desiredOption A
 Degree of recovery at dischargeNo differenceNo differenceNeutral
 Affects natural history of the disease over equivalent timeHigher risk of VTELower risk of VTEOption B
 Population-related benefitsNoneNoneNeutral
 Threshold for population-related benefits reachedNANA
Cost (arising from options A or B)
 Room/care setting costs ($ or time to recovery)No differenceNo differenceNeutral
 Diagnosis/Treatment costs ($)0$10/d × 4-d course = $40/patient
Cost (complications/adverse effects arising from options A or B)
 Likelihood of complication1%–3%0.5%–1.5%
 VTE costs ($): estimated $15 000/episode2% × $15 000 = $3001% × $15 000 = $150
 Bleeding riskNo differenceNo difference, assuming that bleeding risk from prophylaxis negligibleNeutral
 Cost of differential care per patient300190Option B
Annual estimated cost for this care30 00019 000Option B
  • VTE, venous thromboembolism.