What are the costs when your patients have major bleeding episodes?

IPC can be seen as a cost-saving in the prevention of VTE after general surgery¹

References:

1. Nicolaides, A., Goldhaber, S. Z., Maxwell, G. L., Labropoulos, N., Clarke-Pearson, D. L., Tyllis, T. H., & Griffin, M. B. (2008). Cost benefit of intermittent pneumatic compression for venous thromboembolism prophylaxis in general surgery. Int Angiol, 27(6), 500-506.
2. Meta-analysis of 11 trials evaluating IPC plus GCS to no prophylaxis. The model assumed VTE rates as demonstrated in meta-analysis of 54 randomized controlled trials. Clagett, G. P., & Reisch, J. S. (1988). Prevention of venous thromboembolism in general surgical patients. Results of meta-analysis. Ann Surg, 208(2), 227-240.
3. Beyer-Westendorf, J., Lutzner, J., Donath, L., Tittl, L., Knoth, H., Radke, O. C., . . . Werth, S. (2013). Efficacy and safety of thromboprophylaxis with low-molecular-weight heparin or rivaroxaban in hip and knee replacement surgery: findings from the ORTHO-TEP registry. Thromb Haemost, 109(1), 154-163. doi: 10.1160/th12-07-0510.
4. Jensen, C. D., Steval, A., Partington, P. F., Reed, M. R., & Muller, S. D. (2011). Return to theatre following total hip and knee replacement, before and after the introduction of rivaroxaban: a retrospective cohort study. J Bone Joint Surg Br, 93(1), 91-95. doi: 10.1302/0301-620x.93b1.24987
5. Eikelboom, J. W., Quinlan, D. J., & O'Donnell, M. (2009). Major bleeding, mortality, and efficacy of fondaparinux in venous thromboembolism prevention trials. Circulation, 120(20), 2006-2011. doi: 10.1161/circulationaha.109.872630
6. O'Brien, J. A., & Caro, J. J. (2002). Direct medical cost of managing deep vein thrombosis according to the occurrence of complications. Pharmacoeconomics, 20(9), 603-615.

Definitions of major bleeding:

• *Overt bleeding including large wound hematoma with either: a documented transfusion of at least two units of RBC, a surgical revision due to bleeding or, a bleeding into critical site (intracranial, intraocular, intraarticular, retroperitoneal, overt gastrointestinal bleeding), or fatal bleeding.
• ** At 30 days, the risk of death was 7-fold higher among patients with a major bleeding event (8.6% versus 1.7%; adjusted hazard ratio, 6.96; 95% confidence interval, 4.60 to 10.51). There was a consistent pattern of reduced mortality in patients treated with fondaparinux irrespective of whether patients experienced major bleeding (6.8% versus 11.4%; hazard ratio, 0.58; 95% confidence interval, 0.27 to 1.23) or no major bleeding (1.5% versus 1.9%; hazard ratio, 0.77; 95% confidence interval, 0.59 to 1.02; P for heterogeneity=0.47).
• ***Includes any one of the following: hemorrhage due to circulating anticoagulants; subarachnoid, intracerebral or subdural hemorrhage; unspecified hemorrhage; or gastrointestinal hemorrhage.
• ****Includes patients undergoing hip fracture surgery, hip replacement surgery, major knee surgery, abdominal surgery, or acutely ill high-risk medical patients receiving fondaparinux, LMWH, or placebo for VTE prophylaxis.