Bowman Kendra G, Carty Matthew J
Eplasty. 2011;11:e32. Epub 2011 Jul 8.
Preoperative screening for thrombophilias in free flap candidates may be cost-effective.
We developed a model for thrombogenic flap complications using reported thrombophilia prevalences and thromboembolic risk ratios, as well as free flap complication rates from our institution. We performed a break-even and incremental cost-effective ratio analysis for several screening and intervention scenarios.
Our thrombotic free flap complication rate is 4.9%. A full thrombophilia screen breaks even when the cost of complication exceeds $57 000 per patient; a limited screen breaks even at $39 000, and a scenario in which all patients undergo chemoprophylaxis breaks even at $49 000. Incremental cost-effective ratio analyses estimate a cost per avoided flap complication of $33 638 for a full panel scenario, $15 617 for a limited panel scenario and $25 455 for an all therapy scenario.
Our analyses show that preoperative thrombophilia screening may be a cost-effective measure for the prevention of free flap thrombotic complications.
对游离皮瓣移植候选者进行术前血栓形成倾向筛查可能具有成本效益。
我们利用已报道的血栓形成倾向患病率、血栓栓塞风险比以及我们机构的游离皮瓣并发症发生率，建立了一个皮瓣血栓形成并发症模型。我们对几种筛查和干预方案进行了收支平衡分析和增量成本效益比分析。
我们的游离皮瓣血栓形成并发症发生率为4.9%。当并发症成本超过每位患者57000美元时，全面的血栓形成倾向筛查实现收支平衡；有限筛查在39000美元时实现收支平衡，所有患者都接受化学预防的方案在49000美元时实现收支平衡。增量成本效益比分析估计，全面筛查方案中避免皮瓣并发症的成本为33638美元，有限筛查方案为15617美元，全治疗方案为25455美元。
我们的分析表明，术前血栓形成倾向筛查可能是预防游离皮瓣血栓形成并发症的一种具有成本效益的措施。
