Cost-Effectiveness of Pharmacomechanical Catheter-Directed Thrombolysis Versus Standard Anticoagulation in Patients With Proximal Deep Vein Thrombosis: Results From the ATTRACT Trial.
Cost-Effectiveness of Pharmacomechanical Catheter-Directed Thrombolysis Versus Standard Anticoagulation in Patients With Proximal Deep Vein Thrombosis: Results From the ATTRACT Trial.
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近端深静脉血栓形成患者药物机械导管定向溶栓与标准抗凝的成本效益：来自 ATTRACT 试验的结果。
DOI：
10.1161/circoutcomes.119.005659
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Cohe
中科院分区：
文献类型：
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作者：
Magnuson,ElizabethA;Chinnakondepalli,Khaja;Vilain,Katherine;Kearon,Clive;Julian,JimA;Kahn,SusanR;Goldhaber,SamuelZ;Jaff,MichaelR;Kindzelski,AndreiL;Herman,Kevin;Brady,PaulS;Sharma,Karun;Black,CarlM;Vedantham,Suresh;Cohe
背景在急性深静脉血栓形成（DVT）患者中，药物机械导管溶栓（PCDT）联合抗凝治疗越来越多地用于预防血栓后综合征。从美国医疗保健系统的角度来看，这两种治疗策略的长期成本和成本效益尚未进行比较。方法和结果2009年至2014年，ATTRACT试验（急性静脉血栓形成：采用辅助导管引导的血栓溶解术进行血栓清除），将692例急性近端DVT患者随机分配至PCDT+抗凝治疗组（n= 337）或仅抗凝的标准治疗（n= 355）。在24个月的随访期内，使用基于资源的成本计算、医院账单、医疗保险报销率和药物主题红皮书的组合评估了成本（2017美元）。健康状态效用从简表-36中获得。试验结果和美国寿命表被用来开发一个马尔可夫队列模型，以评估终身成本效益。对于PCDT组，初始手术的平均费用为13600;与索引住院相关的每例患者费用，PCDT组为21509，标准治疗组为3877（差异= 17632; 95%CI，16117- 19243）。24个月的费用差异为20045（95%CI，16093 -24120）.两组基线和6个月之间的效用值均显著增加，在任何随访时间点组间均无显著差异.生命时间成本的预计差异为16740，质量调整生命年（Qs）为0.08，PCDT的增量成本-效果比为222041/Qs.非概率敏感性分析，PCD两次生存时间增量成本-效果比<50000/QALY或< 150000/QALY的概率分别为1%和25%，对于10例股静脉DVT，PCD的QALY增量成本-效果比为137526/QALY;对于股腘DVT，标准治疗是经济上占主导地位的策略。对于近端DVT，PCDT不是一种经济上有吸引力的治疗方法。对于髂股DVT患者，PCDT可能具有中等价值。临床试验注册URL https：//www.clinicaltrials.gov.UniqueidentifierNCT00790335。
BackgroundIn patients with acute deep vein thrombosis (DVT), pharmacomechanical catheter-directed thrombolysis (PCDT) in conjunction with anticoagulation therapy is increasingly used with the goal of preventing postthrombotic syndrome. Long-term costs and cost-effectiveness of these 2 treatment strategies from the perspective of the US healthcare system have not been compared.Methods and ResultsBetween 2009 and 2014, the ATTRACT trial (Acute Venous Thrombosis: Thrombus Removal With Adjunctive Catheter-Directed Thrombolysis) randomized 692 patients with acute proximal DVT to PCDT plus anticoagulation (n= 337) or standard treatment with anticoagulation alone (n= 355). Costs (2017 US dollars) were assessed over a 24-month follow-up period using a combination of resource-based costing, hospital bills, Medicare reimbursement rates, and the Drug Topics Red Book. Health state utilities were obtained from the Short Form-36. In-trial results and US life tables were used to develop a Markov cohort model to evaluate lifetime cost-effectiveness. For the PCDT group, mean costs of the initial procedure were 13600;per-patientcostsassociatedwiththeindexhospitalizationwere 21 509 for PCDT and 3877forstandardcare(difference= 17 632; 95% CI, 16117– 19 243). The 24-month difference in costs was 20045(95%CI, 16 093–24120).Utilityscoresincreasedsignificantlybetweenbaselineand6monthsforbothgroups,withnosignificantdifferencesbetweengroupsatanyfollow-uptimepoint.Projecteddifferencesinlifetimecostsof 16 740 and quality-adjusted life years (QALYs) of 0.08, yield an incremental cost-effectiveness ratio for PCDT of 222041/QALYgained.Inprobabilisticsensitivityanalysis,theprobabilitythatPCDTwouldachievealifetimeincrementalcost-effectivenessratio< 50 000/QALY or< 150000/QALYwas1%and25%,respectively.ForiliofemoralDVT,QALYgainswithPCDTweregreater,yieldinganincrementalcost-effectivenessratioof 137 526/QALY; for femoral-popliteal DVT, standard therapy was an economically dominant strategy.ConclusionsWith an incremental cost-effectiveness ratio> 200000/QALYgained,PCDTisnotaneconomicallyattractivetreatmentforproximalDVT.PCDTmaybeofintermediatevalueinpatientswithiliofemoralDVT.ClinicalTrialRegistrationURLhttps://www.clinicaltrials.gov.UniqueidentifierNCT00790335.