Venous thromboembolism: Annualised United States models for total, hospital-acquired and preventable costs utilising long-term attack rates
Venous thromboembolism: Annualised United States models for total, hospital-acquired and preventable costs utilising long-term attack rates
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DOI：
10.1160/th12-03-0162
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发表时间：
2012-08-01
影响因子：
6.7
通讯作者：
Spyropoulos, Alex C.
中科院分区：
文献类型：
--
作者：
Mahan, Charles E.;Borrego, Matthew E.;Spyropoulos, Alex C.
医疗保健改革是对美国（美国）的医疗保健系统。预防工作的优先次序将指导美国医疗保健系统内的必要过渡。虽然最近在美国国家一级定义了每年深静脉血栓形成（DVT）的费用，但每年肺栓塞（PE）和静脉血栓栓塞（VTE）的费用尚未定义。开发了一个决策树和成本模型，以估计美国总PE、总医院获得性PE和总医院获得性“可预防”PE的医疗保健成本。对先前发表的DVT成本模型进行了修改、更新，并与PE成本模型相结合，以阐明VTE的相同三类成本。还说明了直接和间接费用。对于基础模型中的VTE，2011年总成本、医院获得成本和医院获得“可预防”成本的年度成本范围分别为13.5 - 27.2美元、9.0 - 18.2美元和4.5 - 142亿美元。第一项敏感性分析（发病率和成本较高）显示，每年美国总成本、医院获得性成本和医院获得性“可预防”VTE成本分别为32.1 - 69.3美元、23.7 - 51.5美元和11.9 - 393亿美元。第二项敏感性分析（对复发性事件和血栓形成后综合征以及慢性肺血栓栓塞性高血压的长期发作率（LTAR）进行分析）显示，每年美国总的、医院获得的和医院获得的“可预防”VTE成本分别为15.4 - 34.4美元、10.3 - 25.4美元和51 - 191亿美元。PE成本占VTE成本的大部分。有效的静脉血栓栓塞预防策略的优先顺序将降低美国医疗保健系统的成本、发病率和死亡率。成本模型可用于估计其他国家的成本或VTE特定疾病状态。
Healthcare reform is upon the United States (US) healthcare system. Prioritisation of preventative efforts will guide necessary transitions within the US healthcare system. While annual deep-vein thrombosis (DVT) costs have recently been defined at the US national level, annual pulmonary embolism (PE) and venous thromboembolism (VTE) costs have not yet been defined. A decision tree and cost model were developed to estimate US health care costs for total PE, total hospital-acquired PE, and total hospital-acquired "preventable" PE. The previously published DVT cost model was modified, updated and combined with the PE cost model to elucidate the same three categories of costs for VTE. Direct and indirect costs were also delineated. For VTE in the base model, annual cost ranges in 2011 US dollars for total, hospital-acquired, and hospital-acquired "preventable" costs and were $13.5-$27.2, $9.0-$18.2, and $4.5-$14.2 billion, respectively. The first sensitivity analysis, with higher incidence rates and costs, demonstrated annual US total, hospital-acquired, and hospital-acquired "preventable" VTE costs ranging from $32.1-$69.3, $23.7-$51.5, and $11.9-$39.3 billion, respectively. The second sensitivity analysis with long-term attack rates (LTAR) for recurrent events and post-thrombotic syndrome and chronic pulmonary thromboembolic hypertension demonstrated annual US total, hospital-acquired, and hospital-acquired "preventable" VTE costs ranging from $15.4-$34.4, $10.3-$25.4, and $5.1-$19.1 billion, respectively. PE costs comprised a majority of the VTE costs. Prioritisation of effective VTE preventative strategies will reduce significant costs, morbidity and mortality within the US healthcare system. The cost models may be utilised to estimate other countries' costs or VTE-specific disease states.