Obstetrics and Gynecology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
Obstetrics and Gynecology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Int J Gynecol Cancer. 2023 Dec 4;33(12):1875-1881. doi: 10.1136/ijgc-2023-004922.
To determine our institutional rate of venous thromboembolism (VTE) following minimally invasive surgery for endometrial cancer and to perform a cost-effectiveness analysis of extended prophylactic anticoagulation after minimally invasive staging surgery for endometrial cancer.
All patients with newly diagnosed endometrial cancer who underwent minimally invasive staging surgery from January 1, 2017 to December 31, 2020 were identified retrospectively, and clinicopathologic and outcome data were obtained through chart review. Event probabilities and utility decrements were obtained through published clinical data and literature review. A decision model was created to compare 28 days of no post-operative pharmacologic prophylaxis, prophylactic enoxaparin, and prophylactic apixaban. Outcomes included no complications, deep vein thrombosis (DVT), pulmonary embolism, clinically relevant non-major bleeding, and major bleeding. We assumed a willingness-to-pay threshold of $100 000 per quality-adjusted life year (QALY) gained.
Three of 844 patients (0.36%) had a VTE following minimally invasive staging surgery for endometrial cancer. In this model, no pharmacologic prophylaxis was less costly and more effective than prophylactic apixaban and prophylactic enoxaparin over all parameters examined. When all patients were assigned prophylaxis, prophylactic apixaban was both less costly and more effective than prophylactic enoxaparin. If the risk of DVT was ≥4.8%, prophylactic apixaban was favored over no pharmacologic prophylaxis. On Monte Carlo probabilistic sensitivity analysis for the base case scenario, no pharmacologic prophylaxis was favored in 41.1% of iterations at a willingness-to-pay threshold of $100 000 per QALY.
In this cost-effectiveness model, no extended pharmacologic anticoagulation was superior to extended prophylactic enoxaparin and apixaban in clinically early-stage endometrial cancer patients undergoing minimally invasive surgery. This model supports use of prophylactic apixaban for 7 days post-operatively in select patients when the risk of DVT is 4.8% or higher.
确定我们机构在微创治疗子宫内膜癌后静脉血栓栓塞（VTE）的发生率，并对微创分期手术后延长预防性抗凝治疗的成本效益进行分析。
回顾性分析 2017 年 1 月 1 日至 2020 年 12 月 31 日期间接受微创分期手术的所有新诊断为子宫内膜癌的患者，并通过病历回顾获取临床病理和结局数据。通过已发表的临床数据和文献回顾获得事件概率和效用降低。创建一个决策模型，比较 28 天无术后药物预防、预防性依诺肝素和预防性阿哌沙班。结局包括无并发症、深静脉血栓形成（DVT）、肺栓塞、有临床意义的非大出血和大出血。我们假设每获得 1 个质量调整生命年（QALY）的意愿支付阈值为 10 万美元。
844 例患者中有 3 例（0.36%）在微创分期手术后发生 VTE。在该模型中，与预防性阿哌沙班和预防性依诺肝素相比，无药物预防在所有检查参数上均具有更低的成本和更高的效果。当所有患者均接受预防治疗时，预防性阿哌沙班比预防性依诺肝素更具成本效益。如果 DVT 风险≥4.8%，则预防性阿哌沙班优于无药物预防。在基于蒙特卡罗概率敏感性分析的基础案例中，在支付意愿阈值为 10 万美元/QALY 的情况下，无药物预防在 41.1%的迭代中占优势。
在这个成本效益模型中，在接受微创治疗的临床早期子宫内膜癌患者中，不延长药物抗凝治疗优于延长预防性依诺肝素和阿哌沙班。当 DVT 风险为 4.8%或更高时，该模型支持在选择患者中使用预防性阿哌沙班 7 天。
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