Which Approach to Anticoagulation Management is Best?: Illustration of an Interactive Mathematical Model to Support Informed Decision Making
Which Approach to Anticoagulation Management is Best?: Illustration of an Interactive Mathematical Model to Support Informed Decision Making
复制标题
哪种抗凝管理方法最好？：支持明智决策的交互式数学模型说明
DOI：
10.1023/a:1023276710895
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发表时间：
2002
影响因子：
4
通讯作者：
J. McGrann
中科院分区：
文献类型：
--
作者：
G. Samsa;D. Matchar;D. L. Phillips;J. McGrann
背景：在心房颤动或机械心脏瓣膜患者中，确定最佳的口服抗凝治疗方法主要取决于抗凝治疗的成本与避免事件（血栓栓塞和出血）的成本的比较。抗凝管理事件/成本模型（ACME）是一个交互式数学模型，旨在帮助澄清这些权衡。
AbstractBackground: Among patients with atrial fibrillation or mechanical heart valves, determining the best approach to oral anticoagulation largely depends on comparing the costs of anticoagulation management with the costs of events (thromboembolism and bleeding) averted. The Anticoagulation Management Event/Cost Model (ACME) is an interactive mathematical model intended to help clarify these trade-offs.
Methods: The ACME is a series of linked, nested spreadsheets. At the least detailed level, the user specifies the percentage of patients falling into various management strategies (no anticoagulation, usual physician care, anticoagulation service, patient self-testing/self-management), and the ACME estimates event rates and costs. At more detailed levels the ACME performs a series of weighted average calculations combining, for example, utilization times unit price. Cost categories are divided into event-related and management-related costs (costs of management, testing, and medication).
Results: Regardless of how anticoagulation is subsequently managed, perhaps the greatest benefit is obtained by moving patients who are not currently receiving anticoagulation onto warfarin. Additional benefits can be obtained by eliminating outliers (extremely high or extremely low anticoagulation levels). If changing to a more intensive approach also serves to reduce the tendency for physicians to prescribe anticoagulate below the optimal range, additional savings can be anticipated. The cost calculation typically involves a trade-off between increased up-front costs of anticoagulation management versus greater down-line savings associated with a decreased number of events. To assess the quality of anticoagulation within a given organization, it is critical to know the distribution of clotting levels for the population under anticoagulation.
Conclusions: Interactive mathematical models, if sufficiently well documented, can be helpful in clarifying decisions regarding costs and benefits of various methods of anticoagulation.