. 2023 Jan 24;23(1):1–244.

Table 39:

Results of Economic Literature Review—Summary

Author, year, country	Analytic technique, study design, perspective, time horizon	Population	Intervention(s) and comparator(s)	Results
Author, year, country	Analytic technique, study design, perspective, time horizon	Population	Intervention(s) and comparator(s)	Health outcomes	Costs	Cost-effectiveness
Magnuson et al, 2019¹³¹ United States	Type of economic analysis: cost-utility Study design: RCT for first 24 mo in combination with Markov model after 24 mo Perspective: US health care system Lifetime horizon	Inpatients with acute proximal DVT N = 692 n = 337: PMT and/or CDT n = 355 anticoagulation alone Median age: IQR: 53 (42-62) Male: 426 (62%)	Intervention: PMT and/or CDT in conjunction with anticoagulation therapy Mechanical device: AngioJet Rheolytic Thrombectomy System: Boston Scientific, or the Trellis Peripheral Infusion System (Covidien) Comparator: Anticoagulation alone	Total lifetime QALYs: PMT and/or CDT: 17.15 Anticoagulation alone: 17.07 Incremental QALYs: 0.08 Discount rate: 3% annually	2017 USD Total lifetime cost PMT and/or CDT: $168,496 Anticoagulation alone: $151,756 Incremental cost: $16,740 Discount rate: 3% annually Cumulative 24 mo cost (95% CI) PMT and/or CDT: $30,591 ($27,714 to $34,043) Anticoagulation alone: $10,546 ($8,156 to $13,445) Incremental cost: $20,045 ($16,093 to $24,120) Index hospitalization cost (95% CI) PMT and/or CDT: $21,509 ($20,327 to $22,843) Anticoagulation alone: $3,877 ($3,069 to $4,803) Incremental cost: $17,632 ($16,117 to $19,243)	Lifetime model results ICER: $222, 041 per QALY gained Probabilistic analysis: The probability of PMT and/or CDT being cost-effective was 25% at a willingness to pay of $150,000 per QALY gained
Kwok et al, 2018¹³³ Australia	Type of economic analysis: cost analysis Study design: retrospective study Perspective: a hospital in Australia Time horizon: 30 d	Inpatients with noniatrogenic acute lower limb ischemia N = 42 n = 15, primary vacuum aspiration n = 27, primary CDT Mean age ± SD:	Intervention: Primary percutaneous aspiration thrombectomy (vacuum aspiration) Mechanical device: Indigo Aspiration System (Penumbra Inc)	Technical success of thrombus/embolus removal Primary vacuum aspiration: 8 (53%) by the primary intervention only 15 (100%) after the	Costs were converted to US dollars in 2017 using exchange rates The procedural costs were incurred from the initial reperfusion procedure until the return of the patient to a standard nursing ward after	NA
		Primary vacuum aspiration: 69.0 ± 14.5 Primary CDT: 65.0 ± 99 Male: Primary vacuum aspiration: n = 10 (67%) Primary CDT: n = 22 (82%)	Comparator: Primary CDT	primary and adjunctive interventions Primary CDT: 25 (93%) by the primary intervention only 27 (100%) after the primary and adjunctive interventions Limb salvage (avoidance of amputation) at 30 d: Primary vacuum aspiration: 15 (100%) Primary CDT: 27 (100%)	completing treatment Mean ± SD: Primary vacuum aspiration: 16,259 ± 7,452 Primary CDT: 15,175 ± 4,719
Li et al, 2020¹⁰⁰ China	Type of economic analysis: cost analysis Study design: retrospective study Perspective: a hospital in China Time horizon: median follow up time of 6.4 mo for clinical outcomes, but the costs were index hospitalization costs (do not include costs during the follow up)	Inpatients with acute iliofemoral DVT N: 126 PMT + CDT: n = 61; MAT + CDT: n = 65 Mean age ± SD: PMT + CDT: 53.3 ± 14.3 MAT + CDT: 55.3 ± 12.5 Male: PMT + CDT: 33 (54%) MAT + CDT: 34 (52%	Intervention: PMT + CDT Mechanical device: AngioJet Rheolytic Thrombectomy System (Boston Scientific) Comparator: MAT + CDT	Technical success rate: 100% in both groups Thrombus clearance rate: PMT + CDT: 60 (98.4%) MAT + CDT: 65 (100%) P = .311	Authors did not specify the monetary unit or year; we assume USD Costs of the index hospitalization: Mean ± SD: PMT + CDT: $8,291.7 ± 471.4 MAT + CDT: $4,632.5 ± 441.7 P < .001	NA
Li et al, 2021¹³² China	Type of economic analysis: cost-utility Study design: Markov model Perspective: 3rd-party payer, China Time horizon: Lifetime (20 Markov cycles)	Inpatients with lower extremity deep vein thrombosis Age: not reported	Intervention: PMT plus anticoagulation and elastic compression stockings Mechanical device: AngioJet Thrombectomy System (Boston Scientific) Comparator: CDT plus anticoagulation and elastic compression stockings	Total lifetime QALYs^a PMT: 22.56 CDT: 23.83 Discount rate: unknown	Costs are in 2021 USD Total lifetime costs PMT: $24,018 CDT: $49,570 Hospitalization costs of index procedure: PMT: $11,958 CDT: $10,198 Discount rate: unknown	Authors did not calculate ICER, but concluded that PMT would be more cost-effective based on the average cost effectiveness ratio ACER PMT: $1,065/QALY CDT: $2,080/QALY

Abbreviations: ACER, average cost effectiveness ratio; CDT, catheter-directed thrombolysis; DVT, deep vein thrombosis; ICER, incremental cost-effectiveness ratio; IQR, interquartile range; MAT, manual aspiration thrombectomy; NA, not applicable; PMT, pharmacomechanical thrombectomy; QALYs, quality-adjusted life-years; RCT, randomized controlled trial; SD, standard deviation.

The time horizon was 20 Markov cycles (the cycle length was unspecified; we assume 1 year), but it was unclear how they calculated the total effectiveness in both groups to be greater than 20 QALYs given that the maximum value of QALYs after 20 years, without discounting, should be 20. Given this issue, the results of this study may not be reliable.