Cost-effectiveness of inpatient VTE risk assessment tools
Research type
Research Study
Full title
The cost-effectiveness of venous thromboembolism (VTE) risk assessment tools for hospital inpatients
IRAS ID
262220
Contact name
Steve Goodacre
Contact email
Duration of Study in the UK
1 years, 11 months, 30 days
Research summary
Research Summary:
People who are admitted to hospital are at risk of blood clots. Small doses of blood thinning drugs (known as anticoagulants) can reduce the risk of blood clots but with a slightly increased risk of bleeding complications and significant costs to the health service. Risk-assessment tools can be used to determine each patient’s risk of suffering a blood clot and target anticoagulants at higher risk patients. We don’t know how this approach compares to giving anticoagulants to everybody or nobody. This study aims to work out which people in hospital should be given medication to prevent blood clots.We will create a mathematical model to simulate the preventative treatment of people who are admitted to hospital. The model will compare different strategies using risk-assessment to decide which people are given anticoagulants. We will use the findings of previous studies to predict which patients will develop blood clots or bleeding. We will calculate the costs of providing anticoagulants and treating blood clots and bleeding. This will allow us to compare the different strategies and determine which one is the most cost-effective for the NHS.
We will then need to determine whether this strategy can be successfully used in the NHS without causing too many bleeding complications in those given prophylaxis or letting too many people without prophylaxis develop blood clots. This evaluation will require us to collect data from a large number of patients. We therefore plan to test efficient ways of collecting data that will allow us to evaluate risk-assessment tools without disrupting patient care or taking up staff time. We will do this by testing our data collection methods at four NHS hospitals. We will test whether we can collect risk assessment data and use routine hospital data to accurately identify which people develop blood clots or bleeding.
Lay summary of study results: People who are admitted to hospital are at risk of blood clots that can cause serious illness or death. Patients are often given low doses of blood-thinning drugs to reduce this risk. However, these drugs can cause side effects, such as bleeding.
Hospitals currently use complex risk assessment models (risk scores, which usually include patient, disease, mobility and intervention factors) to determine the individual risk of blood clots and identify people most likely to benefit from blood-thinning drugs. There are a lot of different risk scores and we do not know which one is best. We also do not know how these scores compare to each other or whether using scores to decide who should get blood-thinning drugs provides good value for money to the NHS.
We reviewed all previous studies of risk scores. We found that they did not predict blood clots very well and we could not recommend one score over another. We then created a mathematical model to simulate the use of blood-thinning drugs in people admitted to hospital. The model suggested that giving blood-thinning drugs to everyone who could have them would probably provide the best value for money, in medical patients. Our findings were the same, but less certain, for surgical patients.
We also collected information from four NHS hospitals to explore possibilities for future research. Our work showed that routinely collected electronic data on blood clots and bleeding events is not very accurate and that using different scores could result in variable use of blood-thinning medications.
Our findings suggest that it may be better value to the NHS and better for patients if we were to offer blood-thinning medications to everyone on admission to hospital, without using any risk score. However, this approach needs further research to ensure it is safe and effective. Such research would not be able to rely on routine electronic data to identify blood clots or bleeding events, in isolation.
REC name
London - West London & GTAC Research Ethics Committee
REC reference
19/LO/1303
Date of REC Opinion
14 Aug 2019
REC opinion
Favourable Opinion