Ghazvinian Raein, Elf Johan, Löfvendahl Sofia, Holst Jan, Gottsäter Anders
59568Lund University, Lund, Sweden.
Department of Vascular Diseases, 59564Skåne University Hospital, Malmö, Sweden.
Clin Appl Thromb Hemost. 2020 Jan-Dec;26:1076029620937352. doi: 10.1177/1076029620937352.
Direct oral anticoagulants (DOAC) are first line treatment for pulmonary embolism (PE). Treatment of acute PE is traditionally hospital based and associated with high costs. The aims of this study were to evaluate potential cost savings with outpatient DOAC treatment compared to inpatient DOAC treatment in patients with low risk PE. A retrospective study in patients with DOAC treated low risk PE (simplified pulmonary severity index [sPESI] ≤ 1) admitted to 8 hospitals during 2013-2015. Health care costs were compared in 223(44%) patients treated as outpatients and 287(56%) treated in hospital. Total cost per patient was 8293 EUR in the inpatient group, and 2176 EUR in the outpatient group (p < 0.001). Total costs for inpatients were higher (p < 0.001) compared to outpatients in both subgroups with sPESI 0 and 1. In multivariate analysis, type of treatment (in- or outpatient, p = < 0.001) and sPESI group (0 or 1, p = < 0.001) were associated with total cost below or above median, whereas age (p = 0.565) and gender (p = 0.177) was not. Adherence to guidelines recommending outpatient treatment with DOAC in patients with low risk PE enables significant savings.
直接口服抗凝剂（DOAC）是肺栓塞（PE）的一线治疗药物。急性PE的治疗传统上以住院治疗为主，且成本高昂。本研究的目的是评估与住院DOAC治疗相比，门诊DOAC治疗对低风险PE患者潜在的成本节约情况。对2013年至2015年期间在8家医院接受DOAC治疗的低风险PE患者（简化肺栓塞严重程度指数[sPESI]≤1）进行回顾性研究。比较了223例（44%）门诊治疗患者和287例（56%）住院治疗患者的医疗费用。住院组患者的人均总成本为8293欧元，门诊组为2176欧元（p<0.001）。在sPESI为0和1的两个亚组中，住院患者的总成本均高于门诊患者（p<0.001）。多因素分析显示，治疗类型（门诊或住院，p=<0.001）和sPESI分组（0或1，p=<0.001）与总成本低于或高于中位数相关，而年龄（p=0.565）和性别（p=0.177）则无关。对于低风险PE患者，遵循推荐门诊使用DOAC治疗的指南可实现显著的成本节约。
