Increasing use of intermittent pneumatic compression (IPC) sleeve stockings to reduce venous thromboembolism (VTE) risk in stroke patients
Intermittent pneumatic compression (IPC) sleeves have been shown to reduce the risk of deep vein thrombosis (DVT), pulmonary embolism and death among patients who are immobile following a stroke. The CLOTS3 trial showed IPC sleeve use led to a 14% reduction in preventable deaths and 30% relative reduction in risk of DVT.
The Oxford AHSN worked with the Thames Valley Strategic Clinical Network, NHS Improving Quality and partner NHS trusts to demonstrate the value of the compression sleeves and embed their use across the seven stroke units within the Oxford AHSN region. Clinical champions were identified and supported and protocols were shared, standardised and aligned to spread best practice. The uptake and use of IPC sleeves was monitored, reviewed and evaluated.
Independent review
Oxford AHSN commissioned the Office of Health Economics to carry out an independent review to assess the added value of the AHSN innovation adoption approach, this report was published in 2016/17. The assessment included a comparison of local and national utilisation rates between April 2014 and September 2015, alongside any additional resource use associated with the running of the programme. The report concluded that the Oxford AHSN’s innovation adoption approach significantly increased IPC utilisation rates compared to the rest of the country. The OHE estimate that in the 18 month period between April 2014 and September 2015, by achieving higher utilisation rates than the national average, the project prevented an additional 22 DVTs, 2 PEs and 12 deaths within an 18 month period, for an additional cost of £32,286 (cost of sleeves and programme management).
Overall the report concluded that compared to the conventional NICE thresholds for cost-effectiveness the Oxford AHSN innovation adoption approach has delivered good value for money. The cost per VTE avoided was £1307 and the cost per death avoided was £2,526.
Using the same methodology the Oxford AHSN has extended the OHE analysis by a further 9 months with the timescale now spanning April 2014 to June 2016. Over this time-period, by achieving higher utilisation rates than the national average, the AHSN project ensured that an additional 598 patients received IPC sleeves and prevented an additional 30 DVTs, 3 PEs and 18 deaths compared to national utilisation levels. The cost per additional VTE avoided was £1024 and the cost per additional death avoided was £1882.
Assuming utilisation remains constant it is anticipated that by the end of 2017/18 a total of 2500 patients across the region will have received IPC sleeves. This represents the potential for 125 fewer DVTs, 75 fewer deaths and 13 fewer PEs over the lifetime of the project.
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