742: Postpartum venous thromboembolism prophylaxis: A Cost-Effectiveness Analysis

Current postpartum (PP) venous thromboembolism (VTE) prophylaxis (ppx) recommendations are based on consensus and expert opinion. PP VTE can result in morbidity and mortality, but it is a rare event. We compare the cost-effectiveness of three PP VTE ppx strategies in a general obstetric population. We constructed a decision analytic tree to model a population of women in the US under consideration for PP VTE ppx from a health care institution perspective. We considered three strategies: 1) mechanical ppx alone 2) RCOG risk-based protocol and 3) our local risk-based protocol (UAB). We assumed mechanical ppx would be used for all strategies and enoxaparin (LMWH) administered per strategy protocol (broad use for RCOG and narrow use for UAB). Patients with indications for therapeutic anticoagulation were excluded. Model inputs for probability and cost were derived from existing literature. Primary outcome was incremental cost per VTE/pulmonary embolus (PE) death prevented. Secondary outcomes included VTE, PE, death from bleeding attributable to heparin, wound hematoma and heparin-induced thrombocytopenia (HIT). A cost-benefit table was constructed using probabilistic estimates of outcomes and costs in a population of 100,000. One- and two-way sensitivity and probabilistic analyses were performed to explore parametric uncertainty. The incremental cost effectiveness of the UAB and RCOG protocols were $348,385 and $1,069,310 per VTE/PE death prevented, respectively. Mechanical ppx alone was less expensive and less effective than the UAB and RCOG protocols in preventing VTE, PE, and VTE/PE death, but resulted in fewer cases of wound hematoma and HIT (Table). Incremental costs of UAB and RCOG protocols were considerable (Table). In probabilistic analysis, mechanical ppx alone was cost-saving in 85% of 100,000 Monte Carlo simulations with the UAB protocol cost-saving in 15%. One- and two-way analyses showed that the UAB protocol is cost-saving if baseline VTE risk is >1.3%, VTE/PE death cost is >$544,457, PE cost is >$80,196, or LMWH cost is