Department of Radiology, 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA.
Institute of Health System Science, 88982Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.
Clin Appl Thromb Hemost. 2023 Jan-Dec;29:10760296231154553. doi: 10.1177/10760296231154553.
The Management of Anticoagulation in the Periprocedural Period (MAPPP) app is a free tool providing up-to-date guidelines on the periprocedural management of patients on long-term anticoagulants. After validating its effectiveness in the post-procedural period, we aimed to study its overall cost-effectiveness. SF-12 surveys were sent to eligible patients, converted into SF-6D forms, and subsequently into quality-adjusted life years (QALYs) to calculate the incremental cost-effectiveness ratio (ICER). The number of 30-day readmissions was used to calculate hospitalization costs, utilizing publicly available data. From 1/1/2018 to 1/31/2019, 642 patients were screened for enrollment, with an overall response rate of 94% (164/175) among the consented and 49% (164/336) among all eligible patients. The average QALY score was 0.7134 (95% CI [0.6836, 0.7431]) for the patients whose treatment plan followed the MAPPP app recommendations (acceptance group) and 0.7104 (95% CI [0.6760, 0.7448]) for those who did not (rejection group), without statistically significant differences. The difference in ICER scores was -$429 866.67, with the negative sign demonstrating that acceptance was the dominant strategy. By utilizing QALYs and ICER scores we have shown that the acceptance of MAPPP app recommendations is the dominant strategy for the periprocedural management of patients on long-term anticoagulation.
围手术期抗凝管理（MAPPP）应用程序是一个免费工具，提供关于长期抗凝患者围手术期管理的最新指南。在验证其在术后期间的有效性后，我们旨在研究其总体成本效益。向符合条件的患者发送 SF-12 调查，将其转换为 SF-6D 表格，然后转换为质量调整生命年（QALY），以计算增量成本效益比（ICER）。使用公开可用的数据计算 30 天再入院的次数，以计算住院费用。从 2018 年 1 月 1 日至 2019 年 1 月 31 日，对 642 名患者进行了入组筛查，同意入组的患者总体反应率为 94%（164/175），所有合格患者中的反应率为 49%（164/336）。遵循 MAPPP 应用程序建议的患者（接受组）的平均 QALY 评分为 0.7134（95%CI[0.6836,0.7431），而不遵循建议的患者（拒绝组）的平均 QALY 评分为 0.7104（95%CI[0.6760,0.7448），差异无统计学意义。ICER 评分的差异为-429866.67 美元，负号表示接受是主导策略。通过使用 QALY 和 ICER 评分，我们表明接受 MAPPP 应用程序建议是长期抗凝患者围手术期管理的主导策略。
