Baack Kukreja Janet E, Levey Helen R, Ghazi Ahmed, Rashid Hani, Wu Guan, Messing Edward M, Dolan James G
Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, New York.
Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York.
Urol Pract. 2016 Jul;3(4):262-269. doi: 10.1016/j.urpr.2015.08.004. Epub 2016 Apr 8.
Major urological oncology surgery carries a significant risk of postoperative venous thromboembolism events, resulting in major morbidity, possible mortality and substantial costs. We determined the incremental cost-effectiveness for in-hospital and low molecular weight heparin extended duration prophylaxis for venous thromboembolism prevention in patients at high risk following major urological oncology surgery.
A decision analytical model was developed to compare inpatient hospital costs, venous thromboembolism incidence within 365 days and outcomes associated with extended duration prophylaxis for 4 prophylaxis strategies. The 4 strategies grouped by protocol adherence were 1) per protocol in-hospital prophylaxis with extended duration prophylaxis in 88 cases, 2) per protocol in-hospital prophylaxis without extended duration prophylaxis in 42, 3) not per protocol in-hospital prophylaxis with extended duration prophylaxis in 80 and 4) not per protocol in-hospital prophylaxis without extended duration prophylaxis in 99. Between June 2011 and March 2014, 707 patients underwent major urological oncology surgery. Using the Caprini risk score 309 patients were at high risk.
The group 1 strategy was the dominant (most effective) strategy when the probability of preventing venous thromboembolism with extended duration prophylaxis was greater than 80%. Effectiveness for preventing venous thromboembolism was most influenced by the group 2 venous thromboembolism incidence rate. Costs in group 1 vs group 2 were calculated at $1,531 vs $1,563. Using the incremental cost-effectiveness ratio to compare groups 1 and 2, which were the 2 groups with the closest costs and effectiveness, an overall cost savings of $1,390 per patient was seen.
Compared with competing strategies in-hospital and extended duration prophylaxis for venous thromboembolism prevention in patients at high risk undergoing major urological oncology surgery is effective to prevent venous thromboembolism and it is cost saving.
泌尿外科肿瘤大手术术后发生静脉血栓栓塞事件的风险很高，会导致严重的发病情况、可能的死亡以及高昂的费用。我们确定了在泌尿外科肿瘤大手术后高危患者中，住院期间使用低分子量肝素延长预防时间以预防静脉血栓栓塞的增量成本效益。
建立了一个决策分析模型，以比较住院费用、365天内静脉血栓栓塞发生率以及与4种预防策略的延长预防时间相关的结果。根据方案依从性将这4种策略分组为：1）按照方案进行住院预防并延长预防时间的88例，2）按照方案进行住院预防但不延长预防时间的42例，3）未按照方案进行住院预防但延长预防时间的80例，4）未按照方案进行住院预防且不延长预防时间的99例。2011年6月至2014年3月期间，707例患者接受了泌尿外科肿瘤大手术。使用Caprini风险评分，309例患者为高危患者。
当延长预防时间预防静脉血栓栓塞的概率大于80%时，第1组策略是主导（最有效）策略。预防静脉血栓栓塞的有效性受第2组静脉血栓栓塞发生率影响最大。第1组与第2组的成本分别计算为1531美元和1563美元。使用增量成本效益比比较成本和有效性最接近的第1组和第2组，每名患者总体节省成本1390美元。
与其他竞争策略相比，在接受泌尿外科肿瘤大手术的高危患者中，住院期间延长预防时间以预防静脉血栓栓塞是有效的，且具有成本效益。
