Mechanical venous thrombectomy may provide a cost-effective treatment option for patients with iliofemoral deep vein thrombosis

Background: Mechanical venous thrombectomy (MVT) has gained popularity as an alternative to catheter-directed thrombolysis (CDL) and medical management (MM) of iliofemoral deep vein thrombosis (DVT), potentially combining the benefits of a minimally invasive approach with a lower risk of bleeding and shorter hospital stay. Emerging evidence shows MVT to be an effective tool in the DVT treatment. However, the cost-effectiveness of MVT is not well understood. Methods: Incorporating data from Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis Trial, retrospectively published data, and local cost data, we compared the cost-effectiveness of these three treatment modalities (MVT, CDL, and MM) for iliofemoral DVT (IFDVT) using a Markov state-transition model to quantify lifetime costs in 2022 US dollars and effectiveness in quality-adjusted life-years (QALYs). We accounted for perioperative bleeding, long-term risks of post-thrombotic syndrome (PTS), and reintervention. Based on the Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis trial, we assumed a cohort average age of 51 years. A cost-effectiveness acceptability threshold of $100,000/QALY gained was used. Sensitivity analyses were performed. A treatment was dominated when it was less effective and more costly than other options. Results: In the base-case scenario, MVT cost $8092/QALY gained compared with MM, well below the frequently cited $100,000/QALY gained threshold. CDL was dominated, largely due to a greater periprocedural bleeding risk. In one-way sensitivity analyses, if the moderate to severe risk of PTS after MVT was >16.0% (base-case risk, 6.0%), then it would no longer be economically favorable compared with MM at its current procedural cost. In a probabilistic sensitivity analysis, varying all parameters simultaneously over distributions, MVT was favored in 93.6% of model iterations at $100,000/QALY and MM in 4.0% of model iterations. Conclusions: At current cost and outcomes, MVT appears to be a cost-effective intervention for IFDVT compared with anticoagulation alone. Despite marginal decreases in long-term PTS rates, CDL was economically unfavorable. Patients with IFDVT should be considered for MVT from a cost-effectiveness perspective.