An evidence-based cost-effectiveness model on methods of prevention of posttraumatic venous thromboembolism

被引:14
作者
Velmahos, GC
Oh, Y
McCombs, J
Oder, D
机构
[1] Univ So Calif, Keck Sch Med, Dept Surg, Los Angeles, CA USA
[2] Univ So Calif, Sch Pharm, Dept Pharmaceut Econ & Policy, Los Angeles, CA USA
来源
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE | 2000年 / 49卷 / 06期
关键词
trauma; venous thromboembolism; deep venous thrombosis; pulmonary embolism; heparin; sequential compression device; cost-effectiveness;
D O I
10.1097/00005373-200012000-00014
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background:Venous thromboembolism (VT) after injury is a major health problem. Literature data on methods of VT prophylaxis: are not consistent with regard to safety and efficacy, and a recent evidence-based report could not conclude that any method was superior to any other or to no prophylaxis. Because no study exists on the cost-effectiveness (C-E) of the different methods of prophylaxis, data from the evidence-based report were used to design a C-E analysis, This analysis will assist in the design of future randomized trials with adequate power to shaw significant outcome differences. Methods: A decision-tree model was designed on the basis of outcomes from the evidence-based report or relevant literature. We then calculated the cost of prevention of VT by one of the most commonly used methods-low-dose heparin (LDH), low-molecular-weight heparin (LMWH), or sequential compression devices (SCDs)-using different probabilities of incidence of VT. Finally, we adjusted the cost for expected years of life after the episode of VT to calculate the cost per life-year saved by preventing VT. Results: We produced two tables that can be used to calculate the cost per life-year saved for any patient according to his or her age and the method of prophylaxis used. VT prophylaxis becomes less cost-effective as age progresses, because of decreased life-expectancy. With a widely accepted cost limit of $50,000 per life-year saved to indicate cost-effective treatment, LDH is more cost-effective than LMWH or SCDs, Conclusion: Our C-E model can help future investigators plan VT-related research with appropriate sample sizes to evaluate cost effective methods of prophylaxis, LMWH and SCDs must demonstrate substantial improvements in measured outcomes to be more cost-effective than LDH. C-E must be incorporated as a primary outcome in future studies comparing different methods of VT prophylaxis.
引用
收藏
页码:1059 / 1064
页数:6
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