全关节置换术后预防静脉血栓栓塞的成本效益分析：华法林与阿司匹林的比较
Cost-effective prophylaxis against venous thromboembolism after total joint arthroplasty: warfarin versus aspirin.
作者信息
Mostafavi Tabatabaee Reza, Rasouli Mohammad R, Maltenfort Mitchell G, Parvizi Javad
机构信息
The Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, Pennsylvania.
出版信息
J Arthroplasty. 2015 Feb;30(2):159-64. doi: 10.1016/j.arth.2014.08.018. Epub 2014 Sep 6.
Although recent guidelines suggest aspirin for venous thromboembolism (VTE) prophylaxis in low risk patients following total hip arthroplasty (THA) and total knee arthroplasty (TKA), there are no cost-effectiveness studies comparing aspirin and warfarin. In a Markov cohort cost-effectiveness analysis, we found that aspirin cost less and saved more quality-adjusted life-years (QALYs) than warfarin in all age groups. Cost per QALY gained by aspirin was $24,506.20 at age of 55 and $47,148.10 at the age of 85 following THA and $15,117.20 and $24,458.10 after TKA, which were greater than warfarin. In patients undergoing THA/TKA without prior VTE, aspirin is more cost-effective prophylactic agent than warfarin. Warfarin might be a better prophylaxis in TKA patients with high probability of VTE and very low probability of bleeding.
尽管近期指南建议在全髋关节置换术（THA）和全膝关节置换术（TKA）后对低风险患者使用阿司匹林预防静脉血栓栓塞（VTE），但尚无比较阿司匹林和华法林成本效益的研究。在一项马尔可夫队列成本效益分析中，我们发现，在所有年龄组中，阿司匹林的成本低于华法林，且节省的质量调整生命年（QALY）更多。THA后，55岁时阿司匹林每获得一个QALY的成本为24,506.20美元，85岁时为47,148.10美元；TKA后分别为15,117.20美元和24,458.10美元，均高于华法林。在未发生过VTE的THA/TKA患者中，阿司匹林是比华法林更具成本效益的预防药物。对于VTE发生概率高且出血概率极低的TKA患者，华法林可能是更好的预防药物。
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