Inferior vena cava filter retrieval provides no advantage in the average patient

Background Inferior vena cava (IVC) filter placement is performed to mitigate the risk of pulmonary embolism (PE) when anticoagulation is contraindicated or ineffective. Technical advances now allow catheter-based filter retrieval. Many believe the benefits of retrieval are self-evident, yet retriev...

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Bibliographic Details
Published in:Journal of vascular surgery. Venous and lymphatic disorders (New York, NY) NY), 2015-04, Vol.3 (2), p.142-146
Main Authors: Warner, Courtney J., MD, MS, Richey, Elizabeth A., MD, MPH, Tower, Dyane E., DPM, MPH, Condino, Anna E., MD, MPH, Tapp, Stephanie J., PhD, Tosteson, Anna N.A., ScD, Walsh, Daniel B., MD
Format: Article
Language:English
Subjects:
Costs and Cost Analysis
Device Removal - adverse effects
Device Removal - economics
Humans
Male
Pulmonary Embolism - physiopathology
Pulmonary Embolism - prevention & control
Quality-Adjusted Life Years
Retrospective Studies
Surgery
Treatment Outcome
Vena Cava Filters - adverse effects
Vena Cava Filters - economics
Vena Cava, Inferior - pathology
Venous Thrombosis - therapy
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Summary:Background Inferior vena cava (IVC) filter placement is performed to mitigate the risk of pulmonary embolism (PE) when anticoagulation is contraindicated or ineffective. Technical advances now allow catheter-based filter retrieval. Many believe the benefits of retrieval are self-evident, yet retrieval carries an inherent complication risk and cost. The purpose of this study was to quantitatively weigh the risks and benefits of IVC filter retrieval using formal decision analysis. Methods A Markov state-transition model was used to simulate two clinical scenarios: to leave a previously placed IVC filter or to retrieve it. Analysis was performed during the lifetime of the individual, and outcomes were expressed in quality-adjusted life-years (QALYs). The base case is a 60-year-old man with a filter placed within 3 months who no longer requires mechanical thromboprophylaxis. Potential events included PE, filter complications, and death from all other causes during each cycle. Tolls were used to incorporate the disutility of short-term treatment for PE and filter complications. For the base case and sensitivity analyses, we used utilities and probabilities derived from the literature. Results In the base case scenario, leaving the filter in place was preferred to filter retrieval, yielding 22.3 vs 21.9 QALYs. One-way sensitivity analysis demonstrated that filter retrieval may be preferable if the utility of living with a filter is 
ISSN:2213-333X
2213-3348
DOI:10.1016/j.jvsv.2014.12.004