Oster G, Tuden R L, Colditz G A
JAMA. 1987 Jan 9;257(2):203-8.
A number of methods of prophylaxis can reduce the likelihood of postoperative deep-vein thrombosis in patients undergoing major orthopedic surgery. Using techniques of decision analysis, we examine the cost-effectiveness of several of these--warfarin sodium, low-dose subcutaneous heparin sodium, graduated compression stockings, intermittent pneumatic compression, heparin plus dihydroergotamine mesylate, and heparin plus stockings--compared with clinical diagnosis and treatment only. Our results show that 153 deaths per 10 000 patients occur when no prophylaxis is used; with most prophylaxis, this number is at least halved, and the most effective methods may reduce the number of deaths by three fourths. In addition, all of the prophylaxis considered are cost saving: average costs of care (including prophylaxis costs) are reduced by +19.40 to +181.60 per patient. Prophylaxis against deep-vein thrombosis in major orthopedic surgery therefore saves both lives and health care dollars.
多种预防方法可降低接受大型骨科手术患者术后深静脉血栓形成的可能性。我们运用决策分析技术，研究了其中几种方法——华法林钠、低剂量皮下注射肝素钠、分级加压弹力袜、间歇性充气加压、肝素加甲磺酸双氢麦角胺以及肝素加弹力袜——相较于仅进行临床诊断和治疗的成本效益。我们的结果显示，不采取预防措施时，每10000名患者中有153人死亡；采用大多数预防措施后，这一数字至少减半，而最有效的方法可能使死亡人数减少四分之三。此外，所有考虑的预防措施均节省成本：每位患者的平均护理成本（包括预防成本）降低了19.40至181.60美元。因此，在大型骨科手术中预防深静脉血栓形成既能挽救生命，又能节省医疗费用。
