DVT surveillance program in the ICU: analysis of cost-effectiveness.

BACKGROUND: Venous Thrombo-embolism (VTE--Deep venous thrombosis (DVT) and/or pulmonary embolism (PE)--in traumatized patients causes significant morbidity and mortality. The current study evaluates the effectiveness of DVT surveillance in reducing PE, and performs a cost-effectiveness analysis. METHODS: All traumatized patients admitted to the adult ICU underwent twice weekly DVT surveillance by bilateral lower extremity venous Duplex examination (48-month surveillance period--SP). The rates of DVT and PE were recorded and compared to the rates observed in the 36-month pre-surveillance period (PSP). All patients in both periods received mechanical and pharmacologic prophylaxis unless contraindicated. Total costs--diagnostic, therapeutic and surveillance--for both periods were recorded and the incremental cost for each Quality Adjusted Life Year (QALY) gained was calculated. RESULTS: 4234 patients were eligible (PSP--1422 and SP--2812). Rate of DVT in SP (2.8%) was significantly higher than in PSP (1.3%) - p<0.05, and rate of PE in SP (0.7%) was significantly lower than that in PSP (1.5%) - p<0.05. Logistic regression demonstrated that surveillance was an independent predictor of increased DVT detection (OR: 2.53 - CI: 1.462-4.378) and decreased PE incidence (OR: 0.487 - CI: 0.262-0.904). The incremental cost was $509,091/life saved in the base case, translating to $29,102/QALY gained. A sensitivity analysis over four of the parameters used in the model indicated that the incremental cost ranged from $18,661 to $48,821/QALY gained. CONCLUSIONS: Surveillance of traumatized ICU patients increases DVT detection and reduces PE incidence. Costs in terms of QALY gained compares favorably with other interventions accepted by society.

The importance of substate surveillance in detection of geographic oral health inequalities in a small state.

CONTEXT: Considering that 42% of children and adolescents and 91% of dentate adults experience dental caries, oral disease is a public health problem. Although the population's oral health is improving, certain subgroups remain at increased risk for dental disease. OBJECTIVE: To assess the oral health status at the substate level and explore the possibility of geographic oral health inequalities in New Hampshire while building upon existing surveillance data sets. DESIGN: We used the Third Grade Oral Health and NH Behavioral Risk Factor Surveillance System surveys. We ensured the availability of substate level data and compared county/region specific estimates. SETTING: New Hampshire. PARTICIPANT: Adults and third-grade students in public schools. MAIN OUTCOME MEASURES: The prevalence of dental caries, untreated caries, and dental sealants among children; and the insurance status, utilization of dental services, and edentulism among adults. RESULTS: Of the 10 counties, the northernmost Coos County had consistently worse outcomes when compared with other counties. Only 64% of adult Coos County residents reported a dental visit in the past year; of these, 66% reported dental cleaning. Among adults 65 years and older, 29% were edentulous. In comparison with the state overall, these estimates were 76%, 77%, and 19%, respectively. Coos County third-grade students had the highest prevalence of dental caries experience (64% compared with 44% in New Hampshire) and untreated caries (31% compared with 12%), and only 24% had dental sealants (state prevalence is 60%). CONCLUSIONS: Overall oral health status in our state is favorable and comparable with the nation, yet significant geographic inequalities exist among children and adults. The oral health status of disparate groups can be improved using tailored interventions such as community water fluoridation or expansion of school-based dental sealant programs. Surveillance at the substate level is an essential part of the planning, targeting, and progress monitoring.