Oster G, Tuden R L, Colditz G A
Am J Med. 1987 May;82(5):889-99. doi: 10.1016/0002-9343(87)90149-5.
A number of methods of prophylaxis can reduce the risk of postoperative venous thromboembolism in patients undergoing general surgery. The cost-effectiveness of several of these--low-dose subcutaneous heparin, intermittent pneumatic compression, graduated compression stockings, heparin plus dihydroergotamine, heparin plus stockings, and intermittent pneumatic compression plus stockings--was assessed by pooling data from published reports of randomized controlled trials. Using clinical protocols, costs for prophylaxis, diagnosis, and treatment of venous thromboembolism were determined. The expected outcomes and costs of each strategy were then calculated using techniques of decision analysis. The results indicate that stockings are the only prophylactic method that is actually cost-saving. Costs of care average $34 less per admission for patients using stockings than for those receiving no prophylaxis. Most other methods of prophylaxis further reduce thromboembolic risk, but increase costs by $50 to $88 per patient relative to costs for the use of stockings. Differences in the cost-effectiveness of these prophylaxis are more marked, ranging from about $50,000 to almost $500,000 per additional life saved.
多种预防方法可降低普通外科手术患者术后静脉血栓栓塞的风险。通过汇总随机对照试验已发表报告中的数据，评估了其中几种方法——小剂量皮下注射肝素、间歇性充气加压、分级加压弹力袜、肝素加双氢麦角胺、肝素加弹力袜以及间歇性充气加压加弹力袜——的成本效益。采用临床方案确定静脉血栓栓塞的预防、诊断和治疗成本。然后使用决策分析技术计算每种策略的预期结果和成本。结果表明，弹力袜是唯一实际节省成本的预防方法。使用弹力袜的患者每次住院护理费用平均比未接受任何预防措施的患者少34美元。大多数其他预防方法进一步降低了血栓栓塞风险，但相对于使用弹力袜的成本，每位患者的成本增加了50至88美元。这些预防措施在成本效益方面的差异更为显著，每多挽救一条生命的成本从约5万美元到近50万美元不等。
