膝关节镜检查中的静脉血栓栓塞症化学预防：成本的盈亏平衡分析。
Venous Thromboembolism Chemoprophylaxis in Knee Arthroscopy: A Break-Even Analysis of Cost.
机构信息
Penn State Health, Milton S. Hershey Medical Center, Department of Orthopaedics & Rehabilitation, Hershey, Pennsylvania, USA.
出版信息
Am J Sports Med. 2022 Dec;50(14):3832-3837. doi: 10.1177/03635465221130990. Epub 2022 Nov 3.
BACKGROUND
Symptomatic venous thromboembolism (VTE) is a serious and costly complication after knee arthroscopy. There continues to be debate regarding the use of VTE prophylaxis after knee arthroscopy, and minimal research has explored its cost-effectiveness.
HYPOTHESIS
Both aspirin and enoxaparin would be cost-effective in preventing symptomatic VTE.
STUDY DESIGN
Economic and decision analysis; Level of evidence, 3.
METHODS
The literature was searched and the TriNetX research database was queried to determine a range of initial rates of VTE. An open-access retail database was used to determine the mean retail price for aspirin (325 mg) and enoxaparin (30 mg and 40 mg). Our institutional records were used to determine the cost of treating VTE. A "break-even" analysis was then performed to determine the absolute risk reduction necessary to make these drugs cost-effective. This value was then used to calculate the number of patients who would need to be treated (NNT) to prevent a single VTE while still breaking even on cost.
RESULTS
The cost of treating VTE was $9407 (US Dollars). Aspirin (325 mg), enoxaparin (30 mg), and enoxaparin (40 mg) were found to cost $1.86, $188.72, and $99.99, respectively. The low, TriNetX, and high rates of VTE were 0.34%, 0.86%, and 10.9%, respectively. Aspirin was cost-effective at all 3 rates if the initial rate decreased by 0.02% (NNT = 5058). Both formulations of enoxaparin were cost-effective at the high initial rate if they decreased by 2.01% (NNT = 50) and 1.06% (NNT = 94), respectively. However, at the low and TriNetX rates, the 2 doses of enoxaparin were not cost-effective because their final break-even rate exceeded the initial VTE rate.
CONCLUSION
Aspirin and, in some cases, enoxaparin are cost-effective treatments for VTE prophylaxis after knee arthroscopy.
背景
膝关节镜检查后出现有症状的静脉血栓栓塞症（VTE）是一种严重且代价高昂的并发症。对于膝关节镜检查后是否使用 VTE 预防措施，一直存在争议，而且几乎没有研究探讨其成本效益。
假设
阿司匹林和依诺肝素在预防有症状的 VTE 方面都是具有成本效益的。
研究设计
经济和决策分析；证据水平，3 级。
方法
检索文献并查询 TriNetX 研究数据库，以确定 VTE 的初始发生率范围。使用开放访问的零售数据库确定阿司匹林（325 mg）和依诺肝素（30 mg 和 40 mg）的平均零售价格。使用我们的机构记录确定治疗 VTE 的成本。然后进行盈亏平衡分析，以确定使这些药物具有成本效益所需的绝对风险降低。然后使用该值计算需要治疗的患者数量（NNT），以预防单个 VTE 同时仍在成本上保持盈亏平衡。
结果
治疗 VTE 的成本为 9407 美元（美元）。发现阿司匹林（325 mg）、依诺肝素（30 mg）和依诺肝素（40 mg）的成本分别为 1.86 美元、188.72 美元和 99.99 美元。低、TriNetX 和高 VTE 发生率分别为 0.34%、0.86%和 10.9%。如果初始率降低 0.02%（NNT = 5058），则阿司匹林在所有 3 种情况下均具有成本效益。如果初始率降低 2.01%（NNT = 50）和 1.06%（NNT = 94），则两种依诺肝素制剂在高初始率下均具有成本效益。然而，在低和 TriNetX 率下，两种剂量的依诺肝素并不具有成本效益，因为它们的最终盈亏平衡率超过了初始 VTE 率。
结论
阿司匹林和在某些情况下依诺肝素是膝关节镜检查后 VTE 预防的有效治疗方法。
Zotero 插件