Cost-effectiveness of Venous Thromboembolism Prophylaxis After Hospitalization in Patients With Inflammatory Bowel Disease.
Cost-effectiveness of Venous Thromboembolism Prophylaxis After Hospitalization in Patients With Inflammatory Bowel Disease.
复制标题
炎症性肠病患者住院后预防静脉血栓栓塞的成本效益。
DOI：
10.1093/ibd/izab246
复制
发表时间：
2022
影响因子：
4.9
通讯作者：
Faye,AdamS
中科院分区：
文献类型：
--
作者：
Lee,KateE;Lim,Francesca;Colombel,Jean-Frederic;Hur,Chin;Faye,AdamS
背景炎症性肠病(IBD)患者发生静脉血栓栓塞症(VTE)的风险是非IBD患者的2-3倍，且在住院期间持续到出院后风险增加。我们在住院的IBD患者中确定了出院后预防VTE的成本-效果。方法用决策树比较住院患者单独预防与出院后4周利伐沙班10 mg/d预防静脉血栓栓塞症的疗效。我们的主要结果是1年以上的质量调整生命年(QALY)，并使用支付意愿(100,000/QALYfromasocietalperspective.Costs(in2020美元)对策略进行比较，计算增量成本-效果比(ICER)和需要治疗的数量(NNT)以预防1例静脉血栓和静脉血栓死亡。确定性的单向和概率分析评估了模型的不确定性。结果利伐沙班预防与未预防相比，每千人的QALY值增加了1.68倍。在185,778perQALY.TheNNTtopreventasingleVTEwas78，whereastheNNTtopreventasingleVTE-relateddeathwas3190.One-waysensitivityanalysesshowedthathigherVTErisk>；4.5%anddecreasedcostofrivaroxaban≤为280的增量成本下，100,000/QALY.Probabilisticsensitivityanalysesfavoredprophylaxisin28.9%ofiterations.ConclusionsFourweeksofpostdischargeVTEprophylaxisresultsinhigherQALYscomparedwithinpatientprophylaxisaloneandprevents1postdischargeVTEamong78patientswithIBD.AlthoughpostdischargeVTEprophylaxisforallpatientswithIBDisnotcost-effective，可将ICER降低至<；应逐一考虑VTE的风险分布、成本和患者偏好。
Background Patients with inflammatory bowel disease (IBD) have a 2-to 3-fold greater risk of venous thromboembolism (VTE) than patients without IBD, with increased risk during hospitalization that persists postdischarge. We determined the cost-effectiveness of postdischarge VTE prophylaxis among hospitalized patients with IBD. Methods A decision tree compared inpatient prophylaxis alone vs 4 weeks of postdischarge VTE prophylaxis with 10 mg/day of rivaroxaban. Our primary outcome was quality-adjusted life years (QALYs) over 1 year, and strategies were compared using a willingness to pay of 100,000/QALYfromasocietalperspective.Costs(in2020 USD), incremental cost-effectiveness ratios (ICERs) and number needed to treat (NNT) to prevent 1 VTE and VTE death were calculated. Deterministic 1-way and probabilistic analyses assessed model uncertainty. Results Prophylaxis with rivaroxaban resulted in 1.68-higher QALYs per 1000 persons compared with no postdischarge prophylaxis at an incremental cost of 185,778perQALY.TheNNTtopreventasingleVTEwas78,whereastheNNTtopreventasingleVTE-relateddeathwas3190.One-waysensitivityanalysesshowedthathigherVTErisk>4.5%anddecreasedcostofrivaroxaban≤ 280 can reduce the ICER to< 100,000/QALY.Probabilisticsensitivityanalysesfavoredprophylaxisin28.9%ofiterations.ConclusionsFourweeksofpostdischargeVTEprophylaxisresultsinhigherQALYscomparedwithinpatientprophylaxisaloneandprevents1postdischargeVTEamong78patientswithIBD.AlthoughpostdischargeVTEprophylaxisforallpatientswithIBDisnotcost-effective,itshouldbeconsideredinacase-by-casescenario,consideringVTEriskprofile,costs,andpatientpreference.