Health Economics and Clinical Outcomes Research, Xavier University, Cinncinati, Ohio, United States of America.
Coreva Scientific GmbH & Co. KG, Koenigswinter, Germany.
PLoS One. 2023 Jun 29;18(6):e0287812. doi: 10.1371/journal.pone.0287812. eCollection 2023.
To evaluate the cost-effectiveness of using mechanical thromboprophylaxis for patients undergoing a cesarean delivery in Brazil.
A decision-analytic model built in TreeAge software was used to compare the cost and effectiveness of intermittent pneumatic compression to prophylaxis with low-molecular-weight heparin or no prophylaxis from the perspective of the hospital. Related adverse events were venous thromboembolism, minor bleeding, and major bleeding. Model data were sourced from peer-reviewed studies through a structured literature search. A willingness-to-pay threshold of R$15,000 per avoided adverse event was adopted. Scenario, one-way, and probabilistic sensitivity analyses were performed to evaluate the impact of uncertainties on the results.
The costs of care related to venous thromboembolism prophylaxis and associated adverse events ranged from R$914 for no prophylaxis to R$1,301 for low-molecular-weight heparin. With an incremental cost-effectiveness ratio of R$7,843 per adverse event avoided. Intermittent pneumatic compression was cost-effective compared to no prophylaxis. With lower costs and improved effectiveness, intermittent pneumatic compression dominated low-molecular-weight heparin. The probabilistic sensitivity analyses showed that the probability of being cost-effective was comparable for intermittent pneumatic compression and no prophylaxis, with low-molecular-weight heparin unlikely to be considered cost-effective (0.07).
Intermittent pneumatic compression could be a cost-effective option and is likely to be more appropriate than low-molecular-weight heparin when used for venous thromboembolism prophylaxis for cesarean delivery in Brazil. Use of thromboprophylaxis should be a risk-stratified, individualized approach.
评估在巴西行剖宫产术的患者使用机械性血栓预防的成本效益。
采用 TreeAge 软件构建决策分析模型，从医院角度比较间歇气动压迫与低分子肝素预防或不预防的成本效益。相关不良事件包括静脉血栓栓塞、轻微出血和大出血。模型数据来源于经同行评审的研究，通过结构化文献检索获得。采用避免每个不良事件花费 15000 雷亚尔的意愿支付阈值。进行方案、单向和概率敏感性分析，以评估不确定性对结果的影响。
与静脉血栓栓塞预防相关的护理费用及相关不良事件费用范围为：不预防时为 914 雷亚尔，低分子肝素时为 1301 雷亚尔。避免每个不良事件的增量成本效益比为 7843 雷亚尔。与不预防相比，间歇气动压迫具有成本效益。由于成本较低且效果改善，间歇气动压迫优于低分子肝素。概率敏感性分析表明，间歇气动压迫和不预防的成本效益可能性相当，低分子肝素不太可能被认为具有成本效益（0.07）。
间歇气动压迫可能是一种具有成本效益的选择，并且在巴西用于剖宫产术的静脉血栓栓塞预防时，可能比低分子肝素更合适。血栓预防的使用应是一种风险分层、个体化的方法。
