Routine Use of Low-Molecular-Weight Heparin For Deep Venous Thrombosis Prophylaxis After Foot and Ankle Surgery: A Cost-Effectiveness Analysis.
Routine Use of Low-Molecular-Weight Heparin For Deep Venous Thrombosis Prophylaxis After Foot and Ankle Surgery: A Cost-Effectiveness Analysis.
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脚和脚踝手术后，常规使用低分子量肝素预防深静脉血栓形成：成本效益分析。
DOI：
10.1053/j.jfas.2017.12.001
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发表时间：
2018-05
期刊：
影响因子：
--
通讯作者：
Fleischer AE
中科院分区：
文献类型：
--
作者：
Robinson R;Wirt TC;Barbosa C;Amidi A;Chen S;Joseph RM;Fleischer AE
本研究的目的是确定某些足部/踝关节手术是否会受益于常规使用低分子量肝素（LMWH）作为术后DVT预防。我们使用决策分析树进行了正式的成本效益分析，以探讨与无预防方案和常规LMWH预防方案相关的医疗保健成本和健康结局。比较了5种手术的两种情况：1）跟腱修复术（ATR），2）全踝关节置换术（TAA），3）拇外翻手术（HVS），4）后足关节固定术（HA）和5）踝关节骨折手术（AFS）。评估的结果包括短期和长期成本、质量调整生命年（QALY）和获得的每QALY增量成本。从医疗保健系统的角度评估了成本，并以2015年的价格为基础以美元表示。在短期内，常规预防总是与更大的成本相比，没有预防。对于ATR、TAA、HA和AFS，预防与略好的健康结局相关;然而，与预防成本相比，QALY的收益微乎其微（ICER远高于50，000美元/QALY阈值）。对于HVS，预防与更差的健康结果和更高的成本相关。从长期来看，常规预防总是与更差的健康结局相关，要么成本更高（HA，AFS，HVS），要么节省很少（ATR，TAA）。我们的结论是，政策鼓励常规使用LMWH后足/踝关节手术是不太可能的成本效益。应根据具体情况决定是否进行预防，并强调个体患者的风险因素。2、经济与决策分析
The purpose of this study was to determine whether certain foot/ankle surgeries would benefit from routine use of low molecular weight heparin (LMWH) as postoperative DVT prophylaxis. We conducted a formal cost-effectiveness analysis using a decision analytic tree to explore the healthcare costs and health outcomes associated with a scenario of no prophylaxis and a scenario of routine LMWH prophylaxis for 4 weeks. The two scenarios were compared for five procedures: 1) Achilles tendon repair (ATR), 2) total ankle arthroplasty (TAA), 3) hallux valgus surgery (HVS), 4) hindfoot arthrodesis (HA), and 5) ankle fracture surgery (AFS). Outcomes assessed included short and long-term costs, quality-adjusted life-years (QALYs), and incremental cost per QALY gained. Costs were evaluated from the healthcare system perspective and expressed in US dollars at a 2015 price base. In the short-term, routine prophylaxis was always associated with greater costs compared to no prophylaxis. For ATR, TAA, HA and AFS, prophylaxis was associated with slightly better health outcomes; however, the gain in QALYs was minimal compared to the cost of prophylaxis (ICER was well above $50,000/QALY threshold). For HVS, prophylaxis was associated with both worse health outcomes and greater costs. In the long-term, routine prophylaxis was always associated with worse health outcomes and either cost more (HA, AFS, HVS) or saved very little (ATR, TAA). We conclude that policies encouraging routine use of LMWH following foot/ankle surgery are unlikely to be cost-effective. Decisions to perform prophylaxis should be made on a case-by-case basis and emphasize individual patient risk factors. 2, Economic and Decision Analysis
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影响因子：
9.6
作者：
Felcher, Andrew H.;Mularski, Richard A.;Laxson, Steven E.
通讯作者：
Laxson, Steven E.
DOI：
10.1302/0301-620x.92b5.23241
发表时间：
2010-05-01
影响因子：
--
作者：
Healy, B.;Beasley, R.;Weatherall, M.
通讯作者：
Weatherall, M.
影响因子：
9.6
作者：
Kearon, Clive;Akl, Elie A.;Moores, Lisa
通讯作者：
Moores, Lisa
DOI：
10.1302/0301-620x.93b4.25731
发表时间：
2011-04-01
影响因子：
--
作者：
Jameson, S. S.;Augustine, A.;Reed, M. R.
通讯作者：
Reed, M. R.
影响因子：
4.5
作者：
Caprini, JA;Botteman, MF;Cohen, AT
通讯作者：
Cohen, AT