Department of Hematology, Oslo University Hospital, Oslo, Norway.
J Thromb Haemost. 2013 Jun;11(6):1032-42. doi: 10.1111/jth.12184.
Additional treatment with catheter-directed thrombolysis (CDT) has recently been shown to reduce post-thrombotic syndrome (PTS).
To estimate the cost effectiveness of additional CDT compared with standard treatment alone.
Using a Markov decision model, we compared the two treatment strategies in patients with a high proximal deep vein thrombosis (DVT) and a low risk of bleeding. The model captured the development of PTS, recurrent venous thromboembolism and treatment-related adverse events within a lifetime horizon and the perspective of a third-party payer. Uncertainty was assessed with one-way and probabilistic sensitivity analyzes. Model inputs from the CaVenT study included PTS development, major bleeding from CDT and utilities for post DVT states including PTS. The remaining clinical inputs were obtained from the literature. Costs obtained from the CaVenT study, hospital accounts and the literature are expressed in US dollars ($); effects in quality adjusted life years (QALY).
In base case analyzes, additional CDT accumulated 32.31 QALYs compared with 31.68 QALYs after standard treatment alone. Direct medical costs were $64,709 for additional CDT and $51,866 for standard treatment. The incremental cost-effectiveness ratio (ICER) was $20,429/QALY gained. One-way sensitivity analysis showed model sensitivity to the clinical efficacy of both strategies, but the ICER remained < $55,000/QALY over the full range of all parameters. The probability that CDT is cost effective was 82% at a willingness to pay threshold of $50,000/QALY gained.
Additional CDT is likely to be a cost-effective alternative to the standard treatment for patients with a high proximal DVT and a low risk of bleeding.
最近的研究表明，导管溶栓（CDT）的附加治疗可降低血栓后综合征（PTS）的发生率。
评估与单独标准治疗相比，附加 CDT 的成本效益。
使用马尔可夫决策模型，我们比较了两种治疗策略在近端深静脉血栓形成（DVT）高和出血风险低的患者中的应用。该模型在终生和第三方支付者的角度内捕获了 PTS 的发展、复发性静脉血栓栓塞和与治疗相关的不良事件。使用单因素和概率敏感性分析评估了不确定性。CaVenT 研究中的模型输入包括 PTS 的发展、CDT 引起的大出血以及 PTS 等 DVT 后状态的效用。其余的临床输入来自文献。CaVenT 研究、医院账户和文献中获得的成本以美元（$）表示；效果以质量调整生命年（QALY）表示。
在基准案例分析中，与单独标准治疗相比，附加 CDT 累积获得了 32.31 个 QALY，而单独标准治疗获得了 31.68 个 QALY。附加 CDT 的直接医疗费用为 64709 美元，而标准治疗的费用为 51866 美元。增量成本效益比（ICER）为 20429 美元/QALY。单因素敏感性分析显示，模型对两种策略的临床疗效均敏感，但在所有参数的全范围内，ICER 仍低于 55000 美元/QALY。在支付意愿阈值为 50000 美元/QALY 时，CDT 具有成本效益的概率为 82%。
对于近端 DVT 高和出血风险低的患者，附加 CDT 可能是标准治疗的一种具有成本效益的替代方案。
