Defining high risk: cost-effectiveness of extended-duration thromboprophylaxis following major oncologic abdominal surgery.
Defining high risk: cost-effectiveness of extended-duration thromboprophylaxis following major oncologic abdominal surgery.
复制标题
DOI：
10.1007/s11605-013-2373-4
复制
发表时间：
2014-01
期刊：
影响因子：
--
通讯作者：
Noyes K
中科院分区：
文献类型：
--
作者：
Iannuzzi JC;Rickles AS;Kelly KN;Fleming FJ;Dolan JG;Monson JR;Noyes K
延长持续时间血栓预防（EDTPPX）是在出院后21天开具抗血栓治疗处方的做法，通常用于静脉血栓栓塞（VTE）高风险的手术患者。虽然指南推荐使用EDTPPX，但由于缺乏数据，标准模糊不清。成本效益阈值可以进一步说明这些标准。本研究旨在确定与住院预防相比，EDTPPX的成本效益的静脉血栓栓塞发生率阈值。使用决策树比较出院后21天的EDTPPX和住院预防7天的EDTPPX，基本病例假设基于腹部肿瘤切除术，其他方面健康个体无并发症。支付意愿设定为$50,000/QALY。进行敏感性分析以评估模型中的不确定性，特别关注基于静脉血栓栓塞发生率的成本效益阈值。当VTE概率超过2.39%时，EDTPPX为优势策略。考虑到5万美元/QALY的支付意愿阈值，当静脉血栓栓塞发生率分别超过1.22%和0.88%时，EDTPPX是首选策略。当静脉血栓栓塞发生率超过2.39%时，应推荐使用EDTPPX。出院后估计静脉血栓栓塞风险为0.888 ~ 2.39%时，应考虑患者对自我注射和用药费用的偏好。
Extended duration thromboprophylaxis (EDTPPX) is the practice of prescribing antithrombotic therapy for 21 days after discharge, commonly used in surgical patients who are at high risk for venothromboembolism (VTE). While guidelines recommend EDTPPX, criteria are vague due to a paucity of data. The criteria can be further informed by cost-effectiveness thresholds. This study sought to determine the VTE incidence threshold for the cost-effectiveness EDTPPX compared to inpatient prophylaxis. A decision tree was used to compare EDTPPX for 21 days after discharge to 7-days of inpatient-prophylaxis with base case assumptions based on an abdominal oncologic resection without complications in an otherwise healthy individual. Willingness to pay was set at $50,000/QALY. Sensitivity analyses were performed to assess uncertainty within the model, with particular interest in the threshold for costeffectiveness based on VTE incidence. EDTPPX was the dominant strategy when VTE probability exceeds 2.39%. Given a willingness to pay threshold of $50,000/QALY, EDTPPX was the preferred strategy when VTE incidence exceeded 1.22% and 0.88% when using brand name or generic medication costs respectively. EDTPPX should be recommended whenever VTE incidence exceeds 2.39%. When post-discharge estimated VTE risk is 0.88%–2.39% patient preferences about self-injections and medication costs should be considered.